Suspected Gonorrhea Treatment Failure Consultation Form
Suspected gonorrhea cephalosporin treatment failure or any N. gonorrhoeae specimen with decreased cephalosporin susceptibility should be reported directly to CDC by either clinicians or health departments by completing the Suspected Gonorrhea Treatment Failure Consultation Form. Clinicians should contact their state or local health department to coordinate completion of the report form prior to submitting it to CDC.
To report a suspected gonorrhea treatment failure to CDC, please complete and submit this REDCap Survey form. It may be necessary to perform a medical record review or to ask the patient additional questions to complete some parts of the form. Specific sections of the form require completion to submit the form. However, if you do not have all information, please complete the form with as much information as you can. Please do not include any Identifying patient information (e.g., patient name, date of birth, medical record number, social security number).
Clinicians in CDC's Division of STD Prevention will review the form and follow up with submitting providers. If you need immediate clinical assistance, please contact your local or state public health department.
If you have questions about reporting a case to CDC or need assistance with treatment, please contact the Gonorrhea Treatment Failure team (firstname.lastname@example.org; 404-718-5447; Centers for Disease Control and Prevention, Division of STD Prevention).