Gonorrhea: New Treatment Recommendations for Gay Men, MSM

On April 30 the U.S. Centers for Disease Control and Prevention published new U.S. gonorrhea treatment recommendations for men who have sex with men, because of increasing resistance to the drugs recommended until now. The currently recommended treatment is available in oral form, but not in the U.S. at this time, so an injection is usually required for now. From the CDC press release:

"The new CDC-recommended treatment options for MSM with gonorrhea include the injectable antibiotics ceftriaxone, 125-mg IM (for anorectal, pharyngeal, and urogenital cases) and spectinomycin, 2-g IM (for anorectal and urogenital cases only). The antibiotic cefixime is also an option, but is only available in liquid form in the United States."

The previously recommended fluoroquinolones (ciprofloxacin, ofloxacin, or levofloxacin) can still be used in certain cases, provided that a culture is run, or a test for cure, and the patient returns for followup, and re-treatment with a different drug if necessary.

Similar guidelines apply for heterosexuals who acquire gonorrhea in certain states or countries with high prevalence of antibiotic resistance. Nationally in the U.S., the rate of fluoroquinolone-resistant gonorrhea is currently about 5% in men who have sex with men -- about 12 times higher than among heterosexual men. Resistance in 5% of patients is a level at which antibiotic treatment recommendations are often changed.

The new recommendation does not specifically discuss HIV, but gonorrhea is spread by high-risk sexual practices that also spread HIV.

For updated CDC information, see www.cdc.gov/std/gisp.

ISSN # 1052-4207

Copyright 2004 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.