Treatment-Resistant Gonorrhea an Emerging Concern

The emergence of strains of gonorrhea that are resistant to current therapies worries the CDC because no other well-studied and effective treatments are available to treat this sexually transmitted infection. (Image: CDC)

Gonorrhea appears to be developing resistance to currently recommended drugs, a development that concerns the US Centers for Disease Control and Prevention (CDC). The agency warns that if the gonorrhea bacterium loses its susceptibility to cephalosporins, there are no other well-studied and effective treatment options available for this sexually transmitted infection, which can cause infertility and other problems.

The development of cephalaporin-resistant strains of gonorrhea is not a surprise and fits a pattern that public health officials have seen before. In the 1970s, penicillin-resistant and tetracycline-resistant gonorrhea strains emerged and became widespread in the 1980s. This led to use of fluoroquinolones, but then fluoroquinolone resistance emerged. Currently, gonorrhea is treated with a combinations of antibiotics, a cephalosporin (cefixime or ceftriaxone) plus either azithromycin or doxycycline.

In an article published in the June 8 Morbidity and Mortality Weekly Report, the CDC said it has seen a significant increase in the proportion of gonorrhea strains resistant to cefixime and ceftriaxone in the past decade. In 2000, 0.2% of specimens from patients with the infection were found to be less vulnerable to cefixime vs 1.4% of tested specimens in 2010; for ceftriaxone, 0.1% showed decreased susceptibility in 2000 compared with 0.3% of tested specimens in 2010. The findings, based on results from a CDC-sponsored monitoring system of men being treated at sexually transmitted disease clinics, represent about 4% of all annually reported gonorrhea cases.

The increase in resistant strains of gonorrhea appears to be occurring mostly in men who have sex with men, with cefixime-resistant gonorrhea increasing from 0% of test samples in 2000 to 4.0% in 2010 and ceftriaxone-resistant gonorrhea increasing from 0% in 2000 to 0.9% in 2010. The CDC found no statistically significant increases over the same period in treatment-resistant gonorrhea for either cephalosporin in men who have sex exclusively with women.

Based on the findings, the CDC now says that clinicians “should use ceftriaxone and azithromycin for treatment of gonorrhea, remain vigilant for gonorrhea cephalosporin treatment failures, and report treatment failures to their local and state health departments.”

Categories: Public Health, Sexually Transmitted Diseases