Update on multi-drug resistant shigella

SHINE SA, 7/3/2019

The shigella outbreak is continuing in South Australia. This is to advise clinicians to be on alert for a potential increase in shigella cases, and to highlight updated recommendations on treatment as released by the Communicable Disease Control Branch (CDCB).

The outbreak is predominantly in men who have sex with men (MSM) and there is a potential for further increase in numbers related to a larger outbreak in Victoria and NSW. We encourage you to be alert for clients who have recently traveled interstate.The CDCB is now recommending that patients with confirmed multi-drug resistant (MDR) shigella (or at risk of MDR shigella while awaiting sensitivities) be treated with five days of Ceftrixaone 1g IV, rather than 1 day (as recommended in the Public Health Alert issued in December 2018).

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia

Rising Chlamydia and Gonorrhoea Incidence and Associated Risk Factors Among Female Sex Workers in Australia: A Retrospective Cohort Study

Authors

Denton Callander, PhD,*† Hamish McManus, PhD,* Rebecca Guy, PhD,* Margaret Hellard, PhD,‡ Catherine C. O’Connor, DrPH,*§¶ Christopher K. Fairley, PhD,||** Eric P.F. Chow, PhD,||** Anna McNulty, MM,†† David A. Lewis, DA, PhD,‡‡§§ Christopher Carmody, MB, BS,¶¶ Heather-Marie A. Schmidt, PhD,|||| Jules Kim,*** and Basil Donovan, MD*††

From the *The Kirby Institute, †Centre for Social Research in Health,
UNSW Australia, Sydney, NSW; ‡Burnet Institute, Melbourne, VIC;
§RPA Sexual Health Clinic, Community Health, Sydney Local Health
District; ¶Central Clinical School, University of Sydney, Sydney, NSW;
||Melbourne Sexual Health Centre, Alfred Health; **Central Clinical
School, Faculty of Medicine, Nursing and Health Sciences, Monash
University, Melbourne, VIC; ††Sydney Sexual Health Centre,
Sydney Hospital, Sydney; ‡‡Western Sydney Sexual Health Centre,
Parramatta; §§Marie Bashir Institute for Infectious Diseases and
Biosecurity & Sydney Medical School-Westmead, University of
Sydney, Sydney; ¶¶Liverpool Sexual Health Centre, Liverpool; ||||
New South Wales Ministry of Health; and ***Scarlet Alliance, Australian
Sex Worker Association, Sydney, NSW, Australia

Abstract:

Background: Female sex workers in Australia have achieved some of the lowest documented prevalences of human immunodeficiency virus (HIV) and other sexually transmissible infections globally but rates overall are increasing in Australia and warrant closer investigation.

Methods: We constructed a retrospective cohort using repeat testing data extracted from a network of 42 sexual health clinics. Poisson and Cox regression were used to determined trends in incidence and risk factors for HIV, chlamydia, gonorrhoea, and infectious syphilis among female sex workers.

Results: From 2009 to 2015, 18,475 women reporting sex work attended a participating service. The overall incidence of urogenital chlamydia was 7.7/100 person years (PY), declining by 38% from 2009 to 2013 before increasing by 43% to 2015 (P < 0.001); anorectal chlamydia incidence was 0.6/100 PY, and pharyngeal was 1.9/100 PY, which increased significantly during the study period (P < 0.001, both). For gonorrhoea, the urogenital incidence was 1.4/100 PY, anorectal incidence was 0.3/100 PY, P < 0.001), and 3.6/100 PY for pharyngeal; urogenital incidence doubled during the study period, anorectal increased fivefold, and pharyngeal more than tripled (P < 0.001, all). Incidence of infectious syphilis was 0.4/100 PY, which remained stable from 2009 to 2015 (P = 0.09). There were seven incident infections of HIV among female sex workers (0.1/100 PY). Inconsistent condom use with private partners, higher number of private partner numbers, recent injecting drug use, younger age, and country of birth variously predicted sexually transmissible infections among female sex workers.

Conclusions: Although infectious syphilis and HIV remain uncommon in female sex workers attending Australian sexual health clinics, the increasing incidence of gonorrhoea across anatomical sites and increasing chlamydia after a period of decline demands enhanced health promotion initiatives.

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Vaccine for Meningitis Shows Some Protection Against Gonorrhea

New Zealand Family Planning

Some strains of the bacterium that cause gonorrhoea are now resistant to all available antibiotics. With no new drugs on the near horizon, the disease is in desperate need of a vaccine.

Our research, published in the Lancet medical journal this week, shows that protection against gonorrhoea could come from an unexpected source – a vaccine against meningococcal group B disease.

 

 

 

New class of antibiotic raises hopes for urgently-needed gonorrhoea drug

The Guardian, Tuesday 8 August 2017 

A new class of antibiotic has been found to work in the lab against the sexually transmitted infection gonorrhoea, which can cause infertility and damage to babies and is fast becoming resistant to all existing drugs.

Although it is early days, because the antibiotic has yet to be tried in animals or humans, researchers say they are excited by its potential.

Early warning system exposes the rise of the gonorrhoea ‘super-superbug’

The Age, July19th 2017 – 8:32 AM

A critically drug-resistant strain of gonorrhoea dubbed a “super-superbug” has been detected in every Australian state and territory by a new national surveillance system.

The National Alert System for Critical Antimicrobial Resistance (CARAlert) identified 1,064 bacteria highly resistant to last-line antibiotics between 17 March 2016 and 31 March 2017 across 73 laboratories.

Scientists warn that antibiotic-resistant gonorrhoea is on the rise

WHO, 07 July 2017

Every day, more than 1 million sexually transmitted infections are acquired worldwide, and each year an estimated 78 million people are infected with gonorrhoea. New data from 77 countries show that antibiotic resistance is making gonorrhoea much harder – and sometimes impossible – to treat.

The data has been published in PLOS, in two new scientific articles.