Asia Pacific: Emerging drug resistance is a new challenge in syndromic management of STIs

Development of antimicrobial resistance of Neisseria gonorrhoeae to commonly available drugs is a growing challenge in Asia-Pacific region. In overwhelming majority of laboratories in the region, gonococcal resistance testing facility is not available and most of the patients still receive syndromic treatment. Some specialist clinics use on-site microscopy. Current guidelines recommend use of ceftriaxone or cefixime and azithromycin for purulent urethral discharge and azithromycin for non-purulent, mucoid urethral discharge in men and in symptomatic women at high risk of chlamydia. In some countries in the Pacific region (e.g. New Zealand) there has been gradual roll out of NAAT testing for gonorrhoea although NAAT testing for chlamydia has been available universally for a number of years. In view of changing antimicrobial resistance scenario, syndromic management guidelines need to be supported by extensive antimicrobial resistance surveillance.