A six year old boy was brought in to the Emergency Department by his worried parents because he was drowsy and had been complaining of a headache. His parents were concerned that he might have meningitis. He was seen urgently by the paediatricians who noted the boy also had a fever. As meningitis was the most serious possible diagnosis a set of bloods were taken to look for evidence of infection and a lumbar puncture was performed. As soon as the lumbar puncture had been done the boy was started on antibiotics (IV Ceftriaxone) for possible bacterial meningitis whilst waiting for the results of the lumbar puncture and other tests including a urine and blood cultures.
You are busy reading the culture plates in the laboratory when you come across a sample from the Genitourinary Medicine (GUM) clinic growing a Neisseria gonorrhoeae reported as resistant to Ceftriaxone, Azithromycin, Doxycycline, Cefixime and Ciprofloxacin. What would you do? Would you authorise this as normal or would you do anything else? Hopefully this type of resistance pattern would ring alarm bells and prompt further work, but why?
The rising incidence of STIs
In 2015 there were about 435,000 Sexually Transmitted Infections (STIs) diagnosed in the UK. The majority of these were chlamydia at about 200,000. Worryingly the number of cases of gonorrhoea were over 41,200 (an increase of 53% since 2012) and syphilis 5,300 (76% increase since 2012). A lot of the increase is in men who have sex with men (MSM); 80% of gonorrhoea and 90% of syphilis has been in MSMs.
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