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With Resistance to Treatment Rising, CDC Updates Gonorrhea Treatment Guidelines

Last Line of Defense in Treatment Ushered In as Public Health Crisis Looms
Release Date: 
Thursday, August 9, 2012

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William Smith
National Coalition of STD Directors

Washington, D.C. – Today, the Centers for Disease Control and Prevention (CDC) released updated guidelines for the treatment of the sexually transmitted disease gonorrhea, which is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission.[i]CDC estimates there are more than 700,000 gonorrhea infections each year in the United States. The updated guidelines were published in CDC’s Morbidity and Mortality Weekly Report.

The change marks an end to CDC exclusively recommending oral antibiotic treatment as the first line of defense for gonorrhea, and now instead recommends that infections be treated with the injectable antibiotic ceftriaxone in combination with one of two other oral antibiotics, either doxycycline or azithromycin. This change in treatment has significant implications for clinical service delivery and infected patients alike, as the simple act of taking pills is replaced by an administered injection by a certified health professional.

"We applaud the CDC’s preemptive strike of changing recommended treatment and with the intention of extending the life of the last effective drug,” said William Smith, Executive Director of the National Coalition of STD Directors (NCSD). “However, the rising resistance of gonorrhea to our last line of defense against it must be a clarion call to policymakers and private industry alike to invest in the research and development pipeline for new antibiotics and more sophisticated diagnostics…and quickly. We desperately need additional options to meet the challenges of this infection,” continued Smith.

Last summer, the CDC sounded the alarm on gonorrhea’s rising resistance to antimicrobials. This report outlined that we are on the verge of a highly untreatable gonorrhea epidemic as gonorrhea has developed resistance to every class of antibiotics put up against it and there is no new drug in the pipeline. Documented increases in resistance throughout the U.S. are what has prompted the CDC to make the current recommended treatment change.

Also today, the CDC released a Cephalosporin-Resistant Gonorrhea Response Plan that makes a number of important recommendations to clinical providers and state and local health departments to help deal with the rise of antibiotic resistant gonorrhea. In particular, the response plan lays out needed scale ups in the activities of health department staff to monitor resistance and ensure effective treatment of gonorrhea infections.

“The response plan includes a number of recommendations that are imperative to protect the public’s health, but NCSD’s member health departments throughout the country have seen drastic budget cuts, furloughs and layoff of staff, and constricted program activities over the past several years to the point where most are as bare bones as one can imagine,” Smith remarked. “In the face of this real and emerging threat, federal, state, and local governments must reinvest in health department STD programs without delay,” Smith urged.

Estimates conducted by the CDC and released during a NCSD-sponsored Congressional briefing in April suggest that the following could occur as a result of resistance over the next seven years: gonorrhea incidence could increase four-fold to nearly 6 million additional cases; nearly 800 additional HIV infections; a quarter million cases of pelvic inflammatory disease in women; and ultimately, over that seven year window, cost over three-quarter of a billion dollars in lifetime medical costs.

Last year, federal government support to national STD prevention and control efforts at CDC totaled just under $155 million. State and local government contributions vary widely, but the vast majority of health department STD programs have seen significant budget reductions in recent years, some to the point where state and local contributions are zero.

“Finally, we know that resistance to treatment is already highest among gay men and other men who have sex with men (MSM) – the same population where concern rightly looms over increasing rates of HIV infection, especially among young MSM of color,” said Dr. Peter Leone, Chair of NCSD’s Board of Directors. “Treatment-resistant gonorrhea is a major health issue for all Americans, but it is likely to hit this population first and it is likely to have worrisome repercussions for increased HIV infections,” Dr. Leone concluded>


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The National Coalition of STD Directors (NCSD) is a partnership of public health professionals dedicated to promoting sexual health through the prevention of STDs. NCSD provides dynamic leadership that strengthens STD Programs by advocating for effective policies, strategies, and sufficient resources by increasing awareness of the medical and social impacts of STDs.

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[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.