New WHO Treatment Guidelines 2016.

This morning saw the kick off of the STI and HIV World Congress in Rio de Janeiro Brazil.

First off this morning was the 2016 WHO Treatment guidelines - last updated in 2003.

Noting that the new guidelines will be released in 3 stages.

(A.Prof, Director) Magnus Unemo of Swedish Reference Laboratory

Neisseria Gonorrhoea:

Treatment recommendations for Dual therapy over single therapy.

Ano-rectal and UI-

- Ceftriaxone 250mg and 1G Azithromycin 

- Cefixime 400mg PO and 1G Azithromycin.

Oral N.Gonorrhoea-

- Ceftriaxone 250mg and 1G Azithromycin.

- Cefixime 400mg PO and 1G Azithromycin.

It's of importance that currently in Australian Guidelines 500mg of Ceftriaxone is recommended and the WHO recommend 500mg in it's 2nd line treatment when 1st line therapy has suspected treatment failure.

Representitives from the UK and Europe also stated that are currently using 500mg as first line therapy due to high prevalence of resistance.

Dr Nicola Low (University of Bern)

Chlamydia trachomatis 

Take home message- changes in guidelines

- Use of Doxycycline over Azithromycin for Ano-rectal infection.

- 100mg Doxycycline BD for 7 days.

LGV - Treat with Doxycycline 100mg BD for 21 days - was 14 days in previous guidelines. 

Dr Francis Ndowa (Zimbabwe, WHO consultant)

Syphilis

Primary, Secondary and Early latent (2 years or less)

Treatment is with (2.4 million units) 1.8g Benzethine Penicillin IMI Single dose.

Alternate Treatment - Procaine 1.2 IU IMI Daily for 10- 14 days.

Late Syphilis (more than 2 years)

Treatment is 2.4 Million units Benzethine Penicillin IMI one dose one week apart for 3 consecutive weeks.

In penicillin Allergy - 100MG Doxycycline BD for 30 days.

Dr David Lewis (Sydney, Australia)

HSV

19.2 Million new HSV infections in 15 - 49 year olds world wide in 2012.

Recommendation 1 - 1st Episode of HSV infection - treat.

Recommendation 2 - Treatment recommendation Use Aciclovir over Valciclovir or famciclovir.

Dosage 400mg TDS for 10 days.

Recommendation 3 and 4 - Recurrent symptoms treat within 24 hours of symptoms or prodromal phase with Aciclovir 400mg PO TDS for 5 days, 800mg BD for 5 days or 800mg TDS for 2 days

Valciclovir 500mg PO BD for 3 days.

Recommendation 5 - For recurrences of more than 4 per year consider suppressive therapy for 1 year and then reassess. Aciclovir 400mg BD for 1 year.

Dr Manica Balasegaram (Global Antibiotic Research and Development Partnership, GARDP)

Spoke about the development of new treatments for STIs and in particular showed a snap shot of a road map for development of new treatments for N.Gonorrhoea with the main goal of new treatment by 2023.

Main goals of accelerating new agents to be used and investigating existing antibiotics that could be used in new combinations. It's exciting to see that we are looking to the future in regards to Antibiotic stewand ship and treatment of emerging resistance.