More Countries Report Cephalosporin-Resistant Gonorrhea

The number of cases of cephalosporin-resistant gonorrhea is increasing, according to a recent 
report issued by the World Health Organization.¹ Australia, France, Japan, Norway, Sweden,
and the United Kingdom have all reported cases of gonorrhea that show resistance to cephalosporins. This is of significant concern because Neisseria gonorrhoeae, the bacteria that
causes the infection, has already developed resistance to other common antibiotics once used as
treatment, including sulfonilamide, penicillin, tetracycline, and ciprofloxacin.^1,2 Therefore,
cephalosporins have become the last line of defense against the infection.

Worldwide, an estimated 106 million cases of gonorrhea develop each year, and the infection comprises one quarter of the 4 major curable sexually transmitted infections-syphilis, gonorrhea, chlamydia, and trichomoniasis.¹ Gonococcal infections can involve the urethra, cervix, and rectum. Left untreated, gonorrhea can cause infertility in both men and women; significantly increase risk of HIV infection and transmission; increase risk of ectopic pregnancy, spontaneous abortion, stillbirths, and premature delivery; and cause severe eye infections with potential for blindness in up to 50% of babies born to women with the STD.¹

Antimicrobial resistance is a significant public health concern, especially in gonococcal infections. Strains of N gonorrhoeae are able to retain genetic resistance to antibiotics to which they have been previously exposed even after the antibiotics have been discontinued. How extensive this resistance is on a global scale is unknown, partly because of unreliable data in many countries and partly because of insufficient research.¹

Specifically, WHO is asking for greater vigilance on proper use of antibiotics and more research in alternative treatment options for gonococcal infections. The emergence of cephalosporin-resistant gonorrhea on a global scale would significantly complicate treatment and possibly greatly diminish rates of successful treatment of the infection.² To address the potential emergence of cephalosporin-resistant gonorrhea, dual therapy is recommended. For uncomplicated infections, the CDC currently recommends the injectable cephalosporin ceftriaxone in combination with either azithromycin or doxycycline.²

One major challenge to monitoring for antimicrobial-resistant gonorrhea is that most laboratories are trending toward use of newer non-culture-based laboratory technology. At this time, antibiotic susceptibility testing cannot be done using non-culture specimens. It is recommended that all public laboratories should either develop the capacity to perform these tests or partner with a more experienced laboratory that already has the ability to perform culture-based testing.²

Pertinent Point:
- Improved monitoring and reporting of antimicrobial resistance in gonococcal infections, as well
as better prevention, diagnosis, and control of gonococcal infections, is the best defense against
the global emergence of cephalosporin-resistant gonorrhea.

References:

1. World Health Organization. Urgent action needed to prevent the spread of untreatable gonorrhoea. Available at: http://www.who.int/mediacentre/news/notes/2012/gonorrhoea_20120606/en/index.html. Accessed June 8, 2012.2. Centers for Disease Control and Prevention. Antibiotic resistant gonorrhea basic information. Available at: http://www.cdc.gov/std/Gonorrhea/arg/basic.htm. Accessed June 8, 2012.