New Drug Resistant Strain of Gonorrhea Reported

Gonorrhea is a commonly reported sexually transmitted disease in the U.S. with almost half a million cases reported in 2016.  At that time, CDC reported 3.6% of infected persons demonstrated some degree of resistance to the two drugs recommended to treat the infection, azithromycin and ceftriaxone. There has now been a super-resistant strain reported in the United Kingdom with the World Health Organization (WHO) issuing a report on the case, which was completely resistant to both of the recommended antibiotics.  It can be anticipated that it is just a matter of time before similar cases begin to be seen in the U.S. 

The patient contracted the infection that was totally resistant to the recommended antibiotics during a trip to Southeast Asia.   Previously, in the face of antibiotic resistance, increasing the dosage of the recommended drugs would lead to cure; however, in the U.K. case high dose treatment did not eliminate the infection.  A three-day course of intravenous therapy with ertapenem was administered and this was successful.  Clearly, this antibiotic of last resort which is reserved for life-threatening infections in hospitalized patients would not appear appropriate or practical in treatment of gonorrhea infections. 

We seem to be reaching the end of the road in providing rapid, convenient gonorrhea treatment with antibiotics currently available.  There are some antibiotics under development which show some promise.  Work is also being done to develop a vaccine to prevent infection.

Another area of investigation is utilization of antibiotics to which the organism became increasingly resistant over several years and their use abandoned.    However, when abandoned, the entire universe of N. gonorrhea was not resistant to these drugs.  Today, some gonorrhea infections will respond to older, previously discarded drugs.  There are several companies working on technology of rapid point-of-care diagnostics which would provide sensitivity data indicating if any of the older drugs might be used.  The hope is rapid identification and antibiotic sensitivity would prolong the life of a number of these antibiotics.

And finally, if you believe you have a treatment failure in a patient with gonorrhea being treated with azithromycin and ceftriaxone, appropriate specimens should be obtained for culture and sensitivity.  Such a case and isolated organisms need be reported and submitted to the CDC through state and local public health authorities.