CDC Reports an Increase in Cephalosporin-Resistant Gonorrhea

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According to a study published in the July 8 edition of the CDC's Morbidity and Mortality Weekly Report, there appears to be an increase in cephalosporin-resistant gonorrhea.

Gonorrhea is a sexually transmitted disease caused by Neisseria gonorrhoeae. It is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility, and it can facilitate human immunodeficiency virus (HIV) transmission.

The currently CDC recommend dual therapy for gonorrhea , a cephalosporin (ceftriaxone 250 mg) plus either azithromycin or doxycycline, is a result of the past emergence of gonococcal resistance to penicillin and tetracycline (began in the 1970s and became widespread in the early 1980s) and more recently to fluoroquinolones. In 2007, due to this emergence of resistance to fluoroquinolone, the CDC stopped recommending any fluoroquinolone regimens for the treatment of gonorrhea.

Treatment options will become substantially limited if gonorrhea becomes resistant to cephalosporins.

CDC researchers analyzed 10 years' worth of gonorrhea samples (isolates) from men in 30 U.S. cities collected between January 2000 and June 2010 through the U.S. Centers for Disease Control and Prevention's Gonococcal Isolate Surveillance Project (GISP).

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The samples were tested for their minimum inhibitory concentrations (MICs) to cephalosporins (≥0.25 µg/mL for cefixime and ≥0.125 µg/mL for ceftriaxone). MICs measure the lowest concentration of antibiotics needed to halt the growth of gonorrhea bacteria.

During the study period, an average of 5,865 isolates (range: 5,367--6,552) were tested annually. There was a 7 fold increase in resistance to cefixime and a 3 fold increase to ceftriaxone (increased from 0.2% in 2000 to 1.4% in 2010 for cefixime and from 0.1% in 2000 to 0.3% in 2010 for ceftriaxone).

During 2009--2010, 13 (0.11%) of 11,323 isolates had decreased susceptibility to cefixime, compared with seven (0.02%) of 41,462 isolates during 2000--2006 (p

The CDC notes cephalosporins remain an effective treatment for gonococcal infections, but warn that health-care providers should be vigilant for treatment failure.

The CDC also recommends that state and local public health departments should promote maintenance of laboratory capability to culture N. gonorrhoeae to allow testing of isolates for cephalosporin resistance and should develop enhanced surveillance and response protocols for gonorrhea treatment failures and report gonococcal treatment failures to CDC.

Source
CDC MMWR: Cephalosporin Susceptibility Among Neisseria gonorrhoeae Isolates --- United States, 2000--2010; July 8, 2011 / 60(26);873-877

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