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New Hampshire has seen an unprecedented increase in the number of gonorrhea cases. A Health Alert Network (HAN) was sent on January 19, 2017 to notify providers of this outbreak Adobe Acrobat Reader Symbol. Between 2007 and 2013, approximately 130 cases per year were reported to DPHS. As of January 18, 2017, 465 cases have been reported in 2016, which represents a more than 250% increase. Most cases have been in males and in those under 40 years of age. The greatest number of cases has been seen in Hillsborough County, followed by Rockingham, Merrimack, and Strafford Counties.

Drug-resistent Neisseria GonorrhoeaeThe majority of gonorrhea cases (75%) were diagnosed in either private clinician offices, or in an emergency department or urgent care setting. Based on preliminary data, approximately 25% of patients diagnosed with gonorrhea in 2016 were not correctly treated initially according to current CDC recommendations; this is similar whether a patient was treated in a clinician office, or in an emergency department or urgent care setting.

Healthcare providers should take sexual histories Adobe Acrobat Reader Symbol on all patients and test for sexually transmitted diseases (STDs) based on patient risk.

  • Any patient reporting high-risk sexual activity should be screened. This includes new or multiple sex partners, unprotected sex, a sex partner with an STD, exchanging sex for money or drugs, men who have sex with men, etc.
  • All sexually active females aged <25 years, regardless of risk, should be screened annually for Chlamydia trachomatis and Neisseria gonorrhoeae.
  • Patients should be screened at the site of exposure. If patients engage in oral or anal sex, for example, they should be screened for gonorrhea in the oropharynx and rectal areas, respectively.
  • Patients who are sexually active with a partner who was diagnosed with gonorrhea should be evaluated, tested, and empirically treated according to current guidelines.
  • Partners of people with a gonorrhea diagnosis should be tested and treated for exposure.

Due to emerging antibiotic resistance, the only recommended treatment for gonorrhea (cervical, urethral, rectal, or pharyngeal infection) is a two-drug regimen consisting of IM Ceftriaxone and oral Azithromycin. Single drug regimens should not be used.

Gonorrhea Drug Regimen

Oral cefixime is no longer routinely recommended because blood and tissue levels are lower than with IM ceftriaxone, and gonococcal isolates with reduced susceptibility to cefixime have been increasing. Doxycycline is also no longer a recommended therapy due to increasing tetracycline resistance.

The full CDC STD Treatment Guidelines, 2015 can be found at www.cdc.gov/std/treatment/default.htm

Providers are encouraged to work with their infected patient to identify sex partners of the patient and see those sex partners for testing and prophylaxis treatment. These Fact sheets can be printed and provide to patients with a new gonorrhea diagnosis:

Additional resources for health care providers:

Adobe Acrobat Reader Symbol Adobe Acrobat Reader format. You can download a free reader from Adobe.

 
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New Hampshire Department of Health and Human Services
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