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  1. 1

    WHO guidelines for the treatment of Neisseria gonorrhoeae.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2016. [64] p.

    Since the publication of the WHO Guidelines for the management of sexually transmitted infections in 2003, changes in the epidemiology of STIs and advancements in prevention, diagnosis and treatment necessitate changes in STI management. There is an urgent need to update treatment recommendations for gonococcal infections to respond to changing antimicrobial resistance (AMR) patterns of N. gonorrhoeae. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporins, another recommended first-line treatment in the 2003 guidelines, is increasing and several countries have reported treatment failures. These guidelines for the treatment of common infections caused by N. gonorrhoeae form one of several modules of guidelines for specific STIs. It is strongly recommended that countries take updated global guidance into account as they establish standardized national protocols, adapting this guidance to the local epidemiological situation and antimicrobial susceptibility data. The objectives of these guidelines are: to provide evidence-based guidance on treatment of infection with N. gonorrhoeae; and to support countries to update their national guidelines for treatment of gonococcal infection.
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  2. 2
    Peer Reviewed

    Gonorrhoea surveillance, laboratory diagnosis and antimicrobial susceptibility testing of Neisseria gonorrhoeae in 11 countries of the eastern part of the WHO European region.

    Unemo M; Shipitsyna E; Domeika M

    APMIS Acta Pathologica Microbiologica Et Immunologica Scandinavica. 2011 Sep; 119(9):643-649.

    Quality-assured worldwide surveillance of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is crucial for public health purposes. In the countries of the eastern part of the WHO European region the knowledge regarding gonococcal AMR is limited, and antimicrobials of many different types, sources and quality are used for gonorrhoea treatment. This study surveyed gonorrhoea incidence, laboratory diagnosis and gonococcal AMR testing in 11 independent countries of the former Soviet Union. The national gonorrhoea incidences remain mainly high. In general, gonococcal culture and AMR testing were rarely performed, poorly standardized and rarely quality assured. To establish a gonococcal AMR surveillance programme in Eastern Europe, i.e. the geographical area of the former Soviet Union, several actions have recently been undertaken by the Eastern European Sexual and Reproductive Health (EE SRH) Network and the WHO. The information provided herein will be useful in this respect.
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  3. 3

    Surveillance of antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific and South East Asian regions, 2007-2008.

    Tapsall JW; Limnios EA; Abu Bakar HM; Darussalam B; Ping YY; et al.

    Communicable Diseases Intelligence. 2010 Mar; 34(1):1-7.

    Long-term surveillance of antimicrobial resistance in Neisseria gonorrhoeae has been conducted in the World Health Organization (WHO) Western Pacific Region (WPR) to optimise antibiotic treatment of gonococcal disease since 1992. In 2007 and 2008, this Gonococcal Antimicrobial Surveillance Programme (GASP) was enhanced by the inclusion of data from the South East Asian Region (SEAR) and recruitment of additional centres within the WPR. Approximately 17,450 N. gonorrhoeae were examined for their susceptibility to one or more antibiotics used for the treatment of gonorrhoea by external quality controlled methods in 24 reporting centres in 20 countries and/or jurisdictions. A high proportion of penicillin and/or quinolone resistance was again detected amongst isolates tested in North Asia and the WHO SEAR, but much lower rates of penicillin resistance and little quinolone resistance was present in most of the Pacific Island countries. The proportion of gonococci reported as 'resistant', 'less susceptible' or 'non-susceptible' gonococci to the third-generation cephalosporin antibiotic ceftriaxone lay in a wide range, but no major changes were evident in cephalosporin minimal inhibitory concentration (MIC) patterns in 2007-2008. Altered cephalosporin susceptibility was associated with treatment failures following therapy with oral third-generation cephalosporins. There is a need for revision and clarification of some of the in vitro criteria that are currently used to categorise the clinical importance of gonococci with different ceftriaxone and oral cephalosporin MIC levels. The number of instances of spectinomycin resistance remained low. A high proportion of strains tested continued to exhibit a form of plasmid mediated high level resistance to tetracyclines. The continuing emergence and spread of antibiotic resistant gonococci in and from the WHO WPR and SEAR supports the need for gonococcal antimicrobial resistance surveillance programs such as GASP to be maintained and potentially expanded.
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  4. 4

    Epidemic of sexually transmitted diseases in Eastern Europe. Report of a WHO meeting, Copenhagen, Denmark, 13-15 May 1996.

    World Health Organization [WHO]. Regional Office for Europe; Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Copenhagen, Denmark, WHO, Regional Office for Europe, 1996. [3], 14 p. (EUR/ICP/CMDS 08 01 01)

    In response to the alarming rise in sexually transmitted diseases (STDs) in the newly independent states, the WHO Regional Office for Europe, WHO headquarters and the Joint United Nations Programme on AIDS organized a meeting of experts from the most affected countries to exchange information and to identify priority actions for the control of the epidemic. The participants included 15 experts from Belarus, Kazakhstan, Latvia, the Republic of Moldova, the Russian Federation and Ukraine. The participants called for urgent action, including a careful assessment of the existing systems for STD control, reallocation of resources among the various activity areas and strong advocacy to generate awareness at the top level of government and strengthen its support for the recommended initiatives. They also urged that national coordination of programmes to promote sexual health and prevent STDs and HIV be strengthened, that statutory services be made more accessible and acceptable to patients and that efforts be made to ensure that all health workers managing patients with STDs, including those in the private sector, provide high-quality care. (author's)
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  5. 5

    Sexually transmitted infections (STI).

    Hafez B; Goff L

    Advances in Reproduction. 2003; 7(4):217-219.

    Men suffer from a wide variety of STIs. Many of the more serious sexually transmitted infections infect men without causing any symptoms. Population based surveys relying only upon self-reported morbidity will miss the majority of infected men. Objective measures requiring laboratory validation are needed for sexually transmitted infection prevalence estimates. It is clinically easier and more effective to treat STI symptoms in men than in women. The predictive value of these symptoms in men is high: they are more likely to be due to a STI than to anything else. The picture in women is more problematic as endogenous, non-STIs are more common. Management of men with STI should always include treatment options for their sexual partners as well. Untreated STIs in man can lead to male infertility, acquisition and transmission of HIV, and STI transmission to female sexual partners, who may subsequently pass the infection to their unborn children. Not only is male-to-female STI transmission more efficient biologically, social and cultural factors often inhibit women's ability to protect themselves from infection. (author's)
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  6. 6

    The Gonococcal Antimicrobial Surveillance Programme (GASP), WHO Western Pacific Region, 1995.

    World Health Organization [WHO]. Western Pacific Region

    WEEKLY EPIDEMIOLOGICAL RECORD. 1997 Jan 31; 72(5):25-7.

    In 1995, the Gonococcal Antimicrobial Surveillance Program of the World Health Organization's Western Pacific Region examined the susceptibility of 5100 gonococcal isolates to a nominated core group of antibiotics. In the 15 contributing countries, the proportion of isolates resistant to the penicillins by one or more mechanisms ranged from 3.4% (Papua New Guinea) to 97.9% (Viet Nam). Quinolone resistance has been steadily increasing in the Western Pacific Region since 1992 in response to increases in the recommended antibiotic dose and was recorded in nine of the 15 centers in 1995. High-level tetracycline resistance was also present in nine centers in 1995. These findings confirm that gonococcal infections in the Western Pacific Region are becoming more difficult to treat and, as a result, more expensive.
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  7. 7

    Mission report, Regional Office, Manila. Subject: Sexually transmitted diseases surveillance system.

    de Sole G

    [Unpublished] 1992 Mar 3. [4], 29 p. (ICP/GPA/012; RS/91/0545)

    The objectives of this mission of the World Health Organization (WHO) were to establish a region-wide sexually transmitted diseases (STDs) surveillance system by integrating it into the AIDS/HIV infection surveillance system, to evaluate the regional STD program, and to provide STD consultation to other WHO disease prevention and control programs. The annual number of cases of gonorrhea, syphilis, and yaws were reported by 35 countries of the region from 1979 to 1990. China reported STDs only in 1990. In another 6 countries with populations between 10 and 150 millions only 2 countries filed adequate reports. In 6 countries with populations between 1 and 9 million also only 2 countries reported data regularly. 7 countries with adequate reporting were among 22 countries with less than 1 million of population. Vietnam had a major increase in reported gonorrhea and syphilis cases in 1990. In the Philippines the ratio of gonorrhea versus syphilis implied problems with the reporting of syphilis. The ratio of Guam was 4 times higher than expected. The short- and medium-term plan for AIDS contained detailed information on STDs. Findings indicated that: 1) Only gonorrhea and syphilis were reported regularly. Two-thirds of the countries did not report gonorrhea or syphilis with sufficient regularity to allow analysis of trends. 2) Underreporting was the major problem in several countries. 3) There were reporting errors. More systematic collection and feedback by the Regional Office on the Member States should ensure better reporting. Errors should be reduced by validating the information received and improving underreporting (sentinel surveillance and prevalence studies). The control and reporting of genital ulcer disease and syphilis should be strengthened because of evidence that they are risk factors for HIV-1 transmission. The evaluation of primary prevention of AIDS/HIV/STDs by the use of condoms and other measures should be improved. Information on the sex worker system and behavior is needed in most countries.
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  8. 8

    Approaching STDs and AIDS on a global scale. Interview with Peter Piot, Associate Director, Sexually Transmitted Diseases, Global Programme on AIDS (GPA), World Health Organisation (WHO).

    AIDS BULLETIN. 1993 Jul; 2(2):4-5.

    Dr. Piot became involved with the World Health Organization (WHO) Global Program on AIDS (GPA) through his early involvement as Chairman of the WHO Steering Committee on the Epidemiology of AIDS. He responds to questions about the HIV pandemic. Although researchers realized early on that HIV could be transmitted sexually and suspected that condom use could confer protection against HIV infection as it does against other STDs such as gonorrhea and syphilis, only minimal light was shed to the public on the association of HIV with STDs. The delay in clearly pointing out the association stemmed from professionals' lack of desire to further stigmatize HIV/AIDS by designating it as a STD. Furthermore, many Western hematologists had little interest in STDs, and STD control in many countries tended to be coercive. Regarding the risk of HIV infection, Dr. Piot notes that the presence of a genital ulcer caused by syphilis, chancroid, or herpes increases one's risk 10-20-fold; risk increases 3- to 4-fold where gonorrhea or chlamydia are present. Acknowledging the association between STDs and the risk of contracting HIV and understanding the need to control STDs for the prevention of HIV/AIDS, the WHO's STD program was brought under the auspices of and integrated with the GPA. People, and especially women, who may present at STD clinics for treatment are prime candidates for much needed help in avoiding HIV infection; Dr. Piot notes that unlike men, many women do not realize they are infected with an STD until complications develop. Dr. Piot's recent appointment at GPA means the WHO will increase its focus upon the prevention and treatment of STDs. The WHO favors an integrated program approach. Additionally, the GPA plans to develop a short-list of recommended drugs for treating STDs and hopes to develop ways for developing countries to buy them affordably with help from UNICEF and the World Bank. Finally, Dr. Piot explains that, with some exceptions, the prevalence of STDs is lower in developed countries and, therefore, less of a prevention priority.
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  9. 9
    Peer Reviewed

    Global surveillance network for gonococcal antimicrobial susceptibility.


    5-10% of the drugs budget of some developing countries is allocated for drugs which treat people with gonorrhea. Uncontrolled gonorrhea can result in pelvic inflammatory disease which in turn can cause infertility and pregnancy and neonatal infection which in turn can cause blindness. Besides gonococcus does develop resistance to antibiotics. Further resistance consists of both plasmid and chromosomal mediated resistance. Even though there is limited specific data on gonococcal resistance, many countries have high rates of gonococcal infections despite the availability of inexpensive antibiotics such as penicillin and tetracycline. Some gonococcal strains are even resistant to thiamphenicol and sulfamethoxazole-trimethroprim. The remaining antibiotics that gonococcus has not yet developed resistance to (ceftriaxone, ciprofloxacin, and spectinomycin) are costly. Yet their use may be the most cost effective method if the other antibiotics are not working. Health administrators need information on gonococcal antimicrobial susceptibility. Besides resistant gonococcal strains can disperse rapidly with the ease and extent of international travel. So the WHO Sexually Transmitted Diseases (STDs) Programme is organizing a global surveillance network to monitor gonococcal susceptibility to antibiotics now in clinical use and to integrate this with the probable clinic efficacy of these drugs. The 3 interregional coordinating centers include the WHO Collaborating Centre for Reference and Research in Gonocci in Copenhagen, Denmark, Eastern Sydney Area Health Service in Randwick, Australia, and National Laboratory for STDs in Ottawa, Canada. These centers recruit participants from their regions and organize quality control and technical support. They encourage laboratories in developing countries to participate.
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  10. 10

    Fifth African regional conference on sexually transmitted diseases. Report on the sixth conference of the African Union against Venereal Diseases and Treponematoses (AUVDT) held at Harare, Zimbabwe, on 1 to 5 June 1987.

    Osoba AO

    GENITOURINARY MEDICINE. 1987 Dec; 63(6):396-7.

    The themes of the 1987 African conference on venereal diseases were AIDS, penicillinase producing Neisseria gonorrhoea (PPNG), and yaws. The main topic was AIDS, as there are an estimated 50,000 cases in Africa and millions of people who are asymptomatic carriers. An overview of the problem was discussed including the WHO program and its goals on transmission prevention and reduction of death and sickness. There have been 35 countries reporting AIDS cases to WHO but 13 have not reported any. Over 40 papers were presented on the epidemiology, diagnosis, transmission, and infections of AIDS in Africa. A workshop was conducted on the detection of HIV antibody. The discussion on PPNG strains and its increasing number of cases throughout Africa caused re- evaluation of treatment programs. Over 30 papers were presented on PPNG strains and ranged from epidemiological studies to control and management in developing countries. Clinical features of yaws cases were described and the need expressed for strong action to deal with this resurgence. The remaining time was spent on primary care approaches in diagnosis and management of sexually transmitted diseases in rural areas. The decentralization of these services and their integration in primary care units in developing countries was also discussed.
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