Drug-Resistant Gonorrhea Spreading in North America

Gonorrhea, one of the most common sexually transmitted infections, is continuing to develop drug- resistant strains. The bacteria became resistant to sulfonamides in the 1940s, then to penicillins and tetracyclines in the 1970s and 1980s. Fluorquinolones became ineffective by 2007 in the United States and cefixime and ceftriaxone have been used since then. Doctors have seen warning signs of gonorrhea resistance for years as they have had to use higher concentrations of cefixime to cure the disease. A strain of the disease is now resistant to the antibiotic cefixime. This strain was first discovered in Japan and has since spread to Asia and Europe.

A Canadian study has confirmed that cefixime resistance is now in North America. The researchers examined 291 people with gonorrhea infections at a Toronto health clinic. Of 133 patients who returned for follow-up examinations, approximately 7 percent did not respond to treatment.

In August 2012, the U.S. Centers for Disease Control and Prevention changed its recommendations for treating gonorrhea from cefixime to a combination therapy with ceftriaxone and a week-long course of another antibiotic like azithromycin for doxycycline. With the global spread of drug-resistant gonorrhea, the change in treatment recommendations may only be a temporary measure. CDC has suggested, "Reinvestment in gonorrhea prevention and control," and warned that new treatment options for the disease are urgently needed.

The study, "Neisseria gonorrhoeae Treatment Failure and Susceptibility to Cefixime in Toronto, Canada," was published in the Journal of the American Medical Association (2013;309(2):163-170).

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