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Gonorrhea Is Getting Harder to Treat

Gonorrhea poster from WWII

Gonorrhea is easy to treat, right? Just take some antibiotics and you're on your way to recovery. But the Centers for Disease Control and Prevention (CDC) warns that gonorrhea is getting harder to treat because the causative organism has become less susceptible to the dwindling arsenal of effective antibiotics.

Will we be able to keep curing gonorrhea?

Gonorrhea is the second most commonly reported communicable disease in the United States, with an estimated 600,000 cases in the US each year. The STD is caused by the bacteria Neisseria gonorrhoeae, which can be transmitted via any type of sexual activity involving the vagina, penis, anus, or mouth.

The so-called good news about gonorrhea has typically been that if it is treated early enough—before it spreads to the bloodstream or other areas of the body—it can nearly always be cured using antibiotics. Even gonorrhea that spreads typically improves with treatment, despite the fact it is a more serious infection.

In a new perspective report in the New England Journal of Medicine, the authors explained the CDC has warned that gonorrhea is showing increasing resistance to the last class of antibiotics—cephalosporins--that has been highly effective against N. gonorrhoeae.

Last year, the CDC reported that the prevalence of gonorrhea resistant to the cephalosporin called cefixime (Suprax) was 1.4%, which was up from 0.1% in 2006. By mid-2011, the rate had climbed to 1.7%, a 17-fold increase from the 2006 figure.

Among certain populations, however, cephalosporin resistance has increased more; for example, in the western United States, resistance increased from 0.2% in 2006 to 3.6% in 2011. Among men who have sex with men, the rise was from 0.2% to 4.7%.

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On the surface, this resistance may not sound serious, but gonorrhea has a track record of developing resistance to antibiotics. For example, N. gonorrhoeae became resistant to sulfanilamide in the 1940s, to penicillins and tetracyclines in the 1980s, and to fluoroquinolones by 2007.

Typically, the CDC has made new gonorrhea treatment recommendations when resistance surpasses 5%. Now, however, with the figures approaching this mark, there are no treatment options available.

Given this scenario, the authors of the report noted “It is time to sound the alarm” and that “There is much to do and the threat of untreatable gonorrhea is emerging rapidly.”

For now, however, clinicians are left with third-generation cephalosporins for treatment of gonorrhea, which is the CDC’s recommended course. Some of the drugs in this group include ceftriaxone, cefdaloxime, cefdinir, cefetamet, cefixime, cefmenoxime, cefodizime, cefotaxime, and cefpodoxime.

Currently, the most effective approach is an injection of ceftriaxone plus another antibiotic from the macrolide group (azithromycin). The second antibiotic provides additional support and also attacks other pathogens, such as those that cause chlamydia, which often occurs along with gonorrhea.

As gonorrhea gets harder to treat, the authors of the new report emphasize that “investing in rebuilding our defenses against gonococcal infections now…is paramount if we are to control the spread and reduce the consequences of cephalosporin-resistant strains.”

Bolan GA et al. The emerging threat of untreatable gonococcal infection. New England Journal of Medicine 2012; 366:485-87
Centers for Disease Control and Prevention

Image: Courtesy of Wikimedia Commons