New guidance from the CDC suggests the number of treatment-resistant infections to the once curable disease are on the rise, according to research published Feb. 14 in the agency's journal, Morbidity and Mortality Weekly report.
Gonorrhea is the second-most commonly reported STD in the U.S., according to the CDC. It is caused by the Neisseria gonorrhoeae bacterium, and has been treated with antibiotics like penicillin since the 1940s. But over time, genetic mutations have increased the bacteria's resistance to penicillin, necessitating higher doses until the 1980s when several strains of gonorrhea resistant to penicillin and tetracycline antibiotics became widespread in the U.S.
Doctors then moved to using fluoroquinolone antibiotics to treat gonorrhea in the 1990s and early 2000s, but resistant strains popped up in East Asia and the United States. By 2007, about 5 percent of U.S. cases resisted the antibiotics, leading the CDC to no longer recommend them. This left cephalosporins as the only remaining antibiotic recommended for treating gonorrhea.
Following the pattern, strains resistant to cephalosporins began appearing in East Asia in the early 2000s, and eventually strains resistant to the cephalosporin Ceftriaxone made their way to Japan, France and Spain by the end of the decade. In a, the CDC warned doctors to look for cephalosporin-resistant strains and report any cases to health officials.
Now in the latest report, CDC researchers said cephalosporin-resistant strains of gonorrhea might be emerging in the United States, with increasing rates being seen especially in men who have sex with other men (MSM) living in the western United States.
"The development and spread of cephalosporin resistance in N. gonorrhoeae, particularly ceftriaxone resistance, would greatly complicate treatment of gonorrhea," wrote the CDC researchers, who added the previously recommended treatments can't be routinely prescribed either.
That's why they're calling on doctors to "prevent a return to the era of untreatable gonorrhea." Doctors should ask patients for their sexual histories, screen sexually active MSM and high-risk women for gonorrhea at least once a year, if they have it, treat them with a newly-recommended treatments which include cephalosporins and different antibiotics like azithromycin and doxycycline.
"Experience and current data suggest that public health actions outlined in this report provide the best chance of averting the unfavorable outcome of multidrug-resistant gonorrhea," they wrote.
The CDC has more information on gonorrhea.