|
âNew treatment recommendations are critical if we are to continue to see progress in controlling gonorrhea,â
|
|
Key Points of this article
|
|
Within the class of cephalosporins, CDC now recommends ceftriaxone, available as an injection, the preferred treatment for all types of gonorrhea infection (genital, anal, and throat). For genital and anal gonorrhea, there are some alternative oral cephalosporin treatments that physicians can consider, but there are currently no recommended alternatives for pharyngeal infection.
|
|
|
|
|
Ciprofloxacin Resistance
|
|
Resistance to ciprofloxacin was first identified in GISP in 1991. From 1991 to 1998, fewer than 9 ciprofloxacin-resistant isolates were identified each year and such isolates were identified in only a few GISP clinics. In 2000, similar to 1999, 19 (0.4%) ciprofloxacin-resistant GISP isolates were identified in 7 of the 25 GISP clinics. In 2001, 38 (0.7%) ciprofloxacin-resistant GISP isolates were identified in 6 clinics. Two hundred seventy (4.1%) of GISP isolates were resistant to ciprofloxacin (MICs >1.0 g/ml) in 2003, which was two times the proportion identified in 2002 (2.2%, 116/5367). Ciprofloxacin-resistant isolates were identified in 70% (21/30) sentinel sites in 2003. In 2003, no GISP isolates had decreased susceptibility to cefixime or ceftriaxone. The proportion of GISP isolates demonstrating decreased susceptibility to ceftriaxone or cefixime has remained very low over time. To date, no cephalosporin resistance has been identified in GISP. However, it was notable that three of the four isolates with decreased susceptibility to cefixime were also resistant to penicillin, tetracycline, and ciprofloxacin; such multi-drug resistance in combination with decreased susceptibility to cefixime has rarely been identified in the United States
|
|
|
Epidemiology
|
|
Gonorrhea is the second most commonly reported infectious disease in the United States after chlamydia. In 2005, 339,593 cases were reported nationwide, although experts believe the actual number of cases may be twice that. Following a substantial decline in national gonorrhea rates from 1975 to 1997, overall rates appear to have leveled off in recent years.
|
|
By CDC,
[RxPG] The Centers for Disease Control and Prevention (CDC) no longer recommends antibiotics known as fluoroquinolones (ciprofloxacin, ofloxacin, and levofloxacin) as a treatment for gonorrhea in the United States. This limits the options available to treat gonorrhea, one of the most common sexually transmitted diseases in the United States.
The recommendation was prompted by new data released today in CDCâs Morbidity and Mortality Weekly Report (MMWR) showing that fluoroquinolone-resistant gonorrhea is now widespread in the United States among heterosexuals and men who have sex with men (MSM). The data showed the proportion of drug-resistant cases among heterosexuals rising above the recognized threshold of 5 percent for changing treatment recommendations. CDC had recommended fluoroquinolones no longer be used to treat gonorrhea in MSM when this threshold was crossed in earlier years.
The new data, from CDCâs Gonococcal Isolate Surveillance Project (GISP) in 26 U.S. cities, showed that among heterosexual men, the proportion of gonorrhea cases that were fluoroquinolone-resistant Neisseria gonorrhoeae (QRNG) reached 6.7 percent in the first half of 2006, an 11-fold increase from 0.6 percent in 2001.
Recommended options for treating gonorrhea are now limited to a single class of antibiotics known as cephalosporins. Public health officials believe the lack of treatment options underscores the need for accelerated research into new drugs, as well as increased efforts to monitor for emerging drug resistance, especially to cephalosporins.
âThere is also an urgent need for new, effective medicines to treat gonorrhea. We are running out of options to treat this serious disease,â said Dr. Kevin Fenton, Director of CDCâs National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. âIncreased vigilance in monitoring for resistance to all available drugs is essential.â
While significant resistance to cephalosporins has not been observed to date, CDC is working with state and local health departments to monitor emerging cephalosporin resistance. CDC is urging health departments to maintain or develop capacity to perform cultures for Neisseria gonorrhoeae and to assess any gonorrhea treatment failures for possible resistance. In addition, CDC is working with the World Health Organization to strengthen international efforts to monitor for the emergence of cephalosporin resistance and with government and industry partners to identify and evaluate promising new drug regimens. These additional measures are critical for the control of gonorrhea.
Oral fluoroquinolones were recommended as first-line treatments for gonorrhea in 1993. But drug resistant cases have increased steadily in recent years, rising first in the western United States and then among MSM nationwide. In 2002, CDC recommended that fluoroquinolones not be used to treat gonorrhea infections acquired in California and Hawaii, and in 2004 that the drugs no longer be used to treat MSM with these infections.
The new CDC analysis shows an increase in the past five years in the overall proportion of gonorrhea cases that are fluoroquinolone-resistant â from less than 1 percent in 2001 to 13.3 percent in the first half of 2006. The analysis also indicated that fluoroquinolone resistance is widespread geographically. Resistant cases were seen across the United States in the first half of 2006 (in 25 of the 26 cities in the analysis), and sharp increases occurred from 2004 to 2006 in several cities, including Philadelphia (from 1.2 percent to 26.6 percent of gonorrhea cases) and Miami (from 2.1 percent to 15.3 percent). In addition, the analysis showed QRNG continued to rise among MSM; 38 percent of MSM gonorrhea cases were QRNG in the first half of 2006, compared to 1.6 percent in 2001.
Within the class of cephalosporins, CDC now recommends ceftriaxone, available as an injection, the preferred treatment for all types of gonorrhea infection (genital, anal, and throat). For genital and anal gonorrhea, there are some alternative oral cephalosporin treatments that physicians can consider, but there are currently no recommended alternatives for pharyngeal infection.
âNew treatment recommendations are critical if we are to continue to see progress in controlling gonorrhea,â said Dr. John Douglas, director of the Division of STD Prevention. âWe cannot afford to lose ground against a disease that continues to affect roughly 700,000 Americans each year.â
Advertise in this space for $10 per month.
Contact us today.
|
 |
|
Subscribe to Infectious Diseases Newsletter
|
|
|
|
About Dr. Venkat Yelamanchili
|
This news story has been reviewed by Dr. Venkat Yelamanchili before its publication on RxPG News website. Dr. Venkata Yelamanchili , MBBS is a editor of RxPG News. In his capacity as the editor, he is responsible for content related to latest research news in psychiatry. His areas of special interest are General Psychiatry and Therapeutic communities.
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
|
|
Additional information about the news article
|
States participating in GISP include Alabama, Arizona, California, Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland, Michigan, Minnesota, Nevada, New Mexico, North Carolina Ohio, Oklahoma, Oregon, Pennsylvania, Texas, and Washington.
|
|
Feedback
|
For any corrections of factual information, to contact the editors or to send
any medical news or health news press releases, use
feedback form
|
Top of Page
|
