Gonorrhea fast becoming untreatable

The Centers for Disease Control and Prevention (CDC) has updated its treatment recommendations for gonococcal infections because of growing resistance of Neisseria gonorrhoeae to the 1 class of antibiotics-cephalosporins-that remains to treat them.

According to data from CDC’s Gonococcal Isolate Surveillance Project, urethral N. gonorrhoeae isolates collected in the United States between 2006 and 2011 demonstrate declining susceptibility to cefixime.

Reported in CDC’s Morbidity and Mortality Weekly Report, CDC now recommends combination therapy with ceftriaxone 250 mg intramuscularly and either azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days as the most reliably effective treatment for uncomplicated urogenital, anorectal, and pharyngeal gonococcal infections. The experts recommend the injectable form of ceftriaxone because N. gonorrhoeae isolates seem less likely to develop resistance to it than to the oral drug. If this combination therapy fails, CDC recommends that physicians culture relevant specimens and perform antimicrobial susceptibility testing.

CDC no longer recommends cefixime at any dose as first-line treatment. By changing the recommendation, they hope to delay the day when the drug no longer works. If physicians use cefixime because ceftriaxone is unavailable, they should prescribe 400 mg cefixime in a single oral dose along with azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days. In addition, patients should return in 1 week for a test-of-cure at the site of infection.

For patients who are allergic to cephalosporins, CDC recommends azithromycin 2 g in a single oral dose plus a test-of-cure 1 week later.

CDC also reemphasizes the importance of evaluating and treating, if necessary, all sexual partners from the preceding 60 days.

The highest rates of cefixime-resistant

N. gonorrhoeae

isolates in the United States are in the West, where almost 4% of isolates show reduced susceptibility to the drug. Among men who have sex with other men in the Western and Midwestern United States, almost 5% of isolates demonstrate reduced susceptibility.

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