Health Advisory: Increase in Gonorrhea

| August 4, 2017

Actions Requested

  • Be aware that gonorrhea is increasing, especially among people age 20 to 29.
  • Take a sexual history and screen for gonorrhea and other STDs in all sexually active people, especially those at increased risk.
  • Perform routine gonorrhea and chlamydia screening for all sexually active women under age 25, including screening multiple sites (cervix, pharynx and rectum) as appropriate per the sexual history.
  • For men who have sex with men (MSM), screen multiple sites (urethra, pharynx and rectum) as appropriate per the sexual history, and offer appropriate empiric treatment.
  • Test and treat partners of confirmed cases without waiting for test results—or offer exposed partners treatment through the Expedited Partner Therapy (EPT) program.
  • Refer bacterial STD cases among men-who-have-sex-with-men or HIV–infected patients for partner services.

Background

Gonorrhea incidence is increasing in Washington State.

  • In 2012, the incidence was 48.1 (cases per 100,000 people).
  • In 2013, the incidence was 63.8.
  • In 2014, the incidence was 88.1.
  • In 2015, the incidence was 102.8.
  • In 2016, the incidence was 113.7.

CDC is promoting “3 T’s” for healthcare providers:
“Talk, Test and Treat.”

  • Talk:
    Take a sexual history. This is a critical first step in determining risk and next steps. An excellent resource which can help providers take a sexual history can be found here srhd.org/stds-men-having-sex-with-men. This includes a written tool for the patient.
  • Test:
    Comprehensive guidance for screening, see cdc.gov/std/tg2015/screening-recommendations.htm.
  • Treat:
    The recommended regimen is Cefriaxone 250mg IM in a single dose PLUS Azithromycin 1 gram orally in a single dose; administered together on the same day. For comprehensive treatment guidance see www.cdc.gov/std/tg2015/gonorrhea.htm.

Expedited Partner Therapy (EPT) gives healthcare providers the ability to treat your patient’s partners. EPT should be offered to recent (past 60 days) partners of heterosexual patients with gonorrhea or chlamydia. EPT involves calling in or faxing a prescription for chemoprophylaxis in the name of the partner to a participating pharmacy. For more information about EPT see goo.gl/GRHw5A.

Case Reporting

Report cases within three business days.