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What Healthcare Providers Can Do to Slow Gonorrhea’s Growing Resistance to First-line Antibiotics

Posted on by CDC's Safe Healthcare Blog
Jonathan Mermin, MD, MPH, (RADM, USPHS)
Jonathan Mermin, MD, MPH, (RADM, USPHS)

Author: Jonathan Mermin, MD, MPH, (RADM, USPHS),
Director of CDC’s National Center for HIV/AIDS,
Viral Hepatitis, STD, and TB Prevention.

Gonorrhea is the second most commonly reported infectious disease in the United States, with more than 800,000 infections estimated to occur annually. These gonorrhea bacteria are frustratingly nimble in their ability to become resistant to antibiotics previously used to treat them, including sulfonamides, penicillin, tetracycline, and fluoroquinolones. That trend is continuing, with a new report from CDC documenting gonorrhea’s decreasing sensitivity to one of the two remaining drugs available to treat it – azithromycin.

Results from CDC’s Gonococcal Isolate Project (GISP), which monitors for early warning signs of resistance to recommended treatments, show that gonorrhea’s susceptibility to azithromycin recently declined. Reduced susceptibility means that the drug was less effective at stopping the bacteria from growing than before. The number of isolates with reduced azithromycin susceptibility increased more than 300 percent from 0.6% in 2013 to 2.5% in 2014. This is the highest percentage of reduced azithromycin susceptibility since monitoring for the drug began more than 20 years ago.

Declining azithromycin susceptibility occurred in all parts of the country and among men and women.

This is concerning. Increased azithromycin resistance will diminish our ability to cure patients. There are very limited options for treating gonorrhea if the bacteria become resistant to current treatments.

Since 2012, CDC has recommended that healthcare providers treat gonorrhea infection with a dual therapy protocol: a 250 mg intramuscular dose of ceftriaxone in combination with a 1 g oral dose of azithromycin. No isolates in GISP had a decreased susceptibility to both drugs, indicating continued effectiveness of the recommended two-drug regimen.

Here is a list of actions that healthcare providers can take now to help address antibiotic-resistant gonorrhea:

  • Take a sexual history to help you know which sexually transmitted diseases (STDs) to test your patient for and at which anatomical sites.
  • Adhere to CDC’s recommendations by always treating gonorrhea promptly with a combination of injectable ceftriaxone and oral azithromycin, including post-treatment testing to confirm cure, when recommended.
  • Follow CDC screening recommendations, including:
    • All sexually active women younger than 25 years
    • Older women with risk factors, such as new or multiple sex partners or a sex partner who has a sexually transmitted infection
    • Sexually active men who have sex with men (MSM) should be screened at anatomic sites of possible exposure at least annually.
  • Evaluate and treat all patients’ sex partners from the previous 60 days. Expedited Partner Therapy should be considered for heterosexual partners unable or unwilling to access care.
  • Obtain cultures to test for decreased susceptibility from any patients with suspected or documented gonorrhea treatment failures.
  • Report failures of infection to respond to treatment with CDC-recommended therapies to your local health department STD program.
  • Visit CDC’s website for the most current information on gonorrhea treatment.

Thank you for your attention to STD treatment and prevention and to helping us preserve the remaining treatment options for gonorrhea.

Posted on by CDC's Safe Healthcare Blog

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