Neisseria gonorrhoeae notifications, resistance and management in the Pilbara Region, Western Australia, July 2023 – June 2024
DOI:
https://doi.org/10.33321/cdi.2026.50.049Keywords:
Neisseria gonorrhoeae, gonococcal infection, notifications, management, treatment, antimicrobial resistance, Pilbara, Western AustraliaAbstract
Background
In October 2024, Pilbara treatment guidance for uncomplicated urogenital gonorrhoea shifted from routine ZAP pack (amoxicillin 3 g and probenecid 1 g and azithromycin 1 g oral as a single treatment) to ceftriaxone-based LAC pack (ceftriaxone 500 mg in 2 mL 1% lignocaine intramuscularly and azithromycin 1 g oral, as a single treatment) in response to rising penicillinase-producing N. gonorrhoeae (PPNG) and the threat of imported ciprofloxacin resistance.
Design
A retrospective clinical audit to describe demographics, compare treatment and resistance data collected for N. gonorrhoeae notifications for Pilbara health region residents meeting the surveillance case definitions in the Western Australian Notifiable Infectious Diseases Database (WANIDD) against clinical guidelines.
Setting
All Pilbara health region resident N. gonorrhoeae notifications in the Western Australian Notifiable Infectious Diseases Database (WANIDD) from 1 July 2023 to 30 June 2024.
Main outcome measures
The proportion of notifications that reported treatment with a ZAP pack or LAC pack as per Western Australian and national clinical guidelines. Secondary outcomes included the proportion of notifications undertaken by the WA Country Health Service that reported test of cure at 1–2 weeks; the proportion that reported rescreening at 3 months post notification; and the proportion of notifications that reported PPNG and ciprofloxacin resistance.
Results
A total of 188 N. gonorrhoeae notifications were received over the audit time frame. One hundred and twenty-seven notifications of a total of 156 N. gonorrhoeae notifications (81%) reported receiving treatment consistent with WA and National STI treatment guidelines, i.e. ZAP or LAC pack. Fifteen notifications of a total of 188 notifications (8%) reported detection of PPNG and 20 notifications of a total of 188 notifications (11%) reported ciprofloxacin resistance. For WA Country Health service notifications, 9 of 27 (33%) reported re-testing at 1–2 weeks or 3 months.
Conclusions
The majority of notifications (81%) reported N. gonorrhoeae treatment consistent with guidelines. A significant proportion of notifications (8%) indicated likely penicillin resistance due to the detection of PPNG. Reinforcing treatment consistent with the updated treatment guidelines of October 2024 for the Pilbara region will reduce the risk of ineffective treatment. Improving the rate of test of cure and test for reinfection (33%) would improve the likelihood of detecting treatment failure and detecting resistance.
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References
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