S04.2 How should antimicrobial resistance in Neisseria gonorrhoeae influence PID treatment

Abstract

Rising levels of antibiotic resistance in uncomplicated N gonorrhoeae infection have led to changes in recommended treatment and suggestions for new management paradigms. It is, however, unclear how these new approaches to treatment should be reflected in managing gonococcal pelvic inflammatory disease (PID). Gonorrhoea remains an important but relatively uncommon cause of PID for which treatment is often commenced prior to identification of the causative organisms. Those at highest risk (severe symptoms, partner with gonorrhoea, gram negative diplococci on microscopy) should have therapy which includes cover for N gonorrhoeae. Newer agents, such as lefamulin, gepotidacin and zoliflodacin have not been evaluated in women with pelvic infections but frequently have a wide spectrum of activity covering not just gonorrhoea but many of the other bacteria associated with PID, and achieve good tissue levels in the upper genital tract. However, optimal dosing regimens for PID to achieve clearance of infection but minimise the risk of developing future resistance need to be determined.