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CDC Outlines Growing Resistance of Gonorrhea to Treatment

New data outlines urgent need for effective alternative drug treatments
Release Date: 
Friday, July 8, 2011

Washington, DC – Today, the Centers for Disease Control and Prevention (CDC) outlined laboratory trends from 2000-2010 that show growing resistance of gonorrhea to antimicrobials.  Gonorrhea, a sexually transmitted disease (STD), is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission.[i]

Published in the July 8, 2011 issue of Morbidity and Mortality Weekly Report (MMWR), the article, “Cephalosporin Susceptibility Among Neisseria gonorrhoeae Isolates — United States, 2000–2010,” summarizes gonorrhea’s growing resistance to antibiotics.  These cephalosporin antibiotics are the last line of defense for treating the disease, as the bacteria has developed resistance to all other antibiotics.  The highest level of resistance to cephalosporins, regardless of sexual partner, was found in the Western region of the United States, particularly Hawaii and California, as well as in men who have sex with men in all regions.

“This new data outlines what state and local health departments have been seeing on the ground—that highly untreatable gonorrhea is near,” stated William Smith, Executive Director of the National Coalition of STD Directors. “There are currently no new drugs in development for this infection.  If this last class of drugs fails we will have no definitive treatment options for gonorrhea.  We call on researchers, government, and partners in industry to make the development of new, effective drug treatments for gonorrhea a public health priority,” continued Smith.

There have been no treatment failures documented in the United States.  This pattern of increased resistance, however, is similar to the bacteria’s past resistance to other types of antibiotics, leading many in the medical community to conclude that untreatable gonorrhea may be on the horizon if we do not act.  As the report states: “In light of the past inability to prevent emergence of resistance and of diminished resources available to STD control programs, the eventual emergence of cephalosporin resistance appears inevitable.  Actions undertaken now could delay the spread of cephalosporin-resistance strains and mitigate the public health consequences.”

It is critical for health care providers to be aware of the potential for future resistance and take three critical steps to ensure successful treatment outcomes: treat promptly, according to CDC recommendations; culture if a patient has suspected treatment failure; and report suspected treatment failures to state and local health departments.  Additionally, both public and private partners must make new treatment solutions a priority. 

The CDC estimates that more than 700,000 persons in the U.S. get new gonorrheal infections each year.  It is also an STD that disproportionally affects minorities.  According to the CDC, the gonorrhea rate among blacks is 20 times higher than whites.  In 2009, blacks accounted for 71% of all gonorrhea cases, though they represent only 14% of the U.S. population.

This publication comes on the heels of the CDC’s documenting a case of gonorrhea in Hawaii exhibiting high-level resistance to azithromycin as well as an earlier MMWR report documenting five cases of gonorrhea in men that have sex with men in California with reduced susceptibility to azithromycin.  CDC currently recommends dual therapy treatment of gonorrhea with a cephalosporin (ceftriaxone 250 mg) plus either azithromycin or doxycycline.

The full Morbidity and Mortality Weekly Report article can be found on CDC’s website.

[i] 1.Fleming D, Wasserheit J. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Trans Infect 1999;75:3--17.