Resistance to azithromycin, an antibiotic used to treat gonorrhea, is emerging, according to CDC findings published today in the Morbidity and Mortality Weekly Report.
CDC currently recommends a combination gonorrhea treatment with two antibiotics -- an oral dose of azithromycin and single shot of ceftriaxone. Findings released today from CDC's surveillance system for monitoring the threat of antibiotic-resistant gonorrhea show that the percentage of gonorrhea isolates with decreased susceptibility to azithromycin, an indicator of emerging resistance, increased more than 400 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent of gonorrhea isolates). This is a distressing sign that the future of current treatment options may be in jeopardy and underscores the importance of the federal government's Combating Antibiotic Resistant Bacteria (CARB) Action Plan.
"The confluence of emerging drug resistance and very limited alternative options for treatment creates a perfect storm for future gonorrhea treatment failure in the U.S.," said Jonathan Mermin, M.D., director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention. "History shows us that bacteria will find a way to outlast the antibiotics we're using to treat it. We are running just one step ahead in order to preserve the remaining treatment option for as long as possible."
The combination therapy currently recommended by CDC still works. To date, no treatment failures have been reported in the United States. But signs of emerging resistance to azithromycin suggests that this drug will be next in the long line of antibiotics to which gonorrhea bacteria have become resistant -- a list that includes penicillin, tetracycline, and fluoroquinolones. Because of gonorrhea's ability to outsmart the antibiotics used to treat it, CDC has been closely monitoring early warning signs of resistance not only to azithromycin but also to cephalosporins, the class of antibiotics that includes ceftriaxone.
"It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persist," said Gail Bolan, M.D, director of CDC's Division of STD Prevention. "We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it."
Gonorrhea Cases Increasing
Gonorrhea is one of the most common STDs in the United States, and the 2014 STD surveillance report indicates that gonorrhea and other reportable STDs are on the rise.
"The growing threat of untreatable gonorrhea, combined with increasing rates of disease, makes it more important than ever to prevent new infections" Mermin said. "There is a critical need to strengthen STD prevention services. Gonorrhea and other STDs can currently be prevented, diagnosed and treated - action today is essential to prevent worse outcomes tomorrow."
CDC is taking action by collaborating with state and local health departments and community partner organizations to extend the reach of existing STD prevention services. This includes programs like Improving STD Programs through Assessment, Assurance, Policy Development and Prevention Strategies (STD AAPPS), which provides funding to all 50 states to decrease the burden of STDs, and Community Approaches to Reducing Sexually Transmitted Diseases (CARS), which leverages community resources and partners to reduce STD disparities.
As part of the broader CARB Action Plan, CDC is specifically addressing the threat of antibiotic resistant gonorrhea by working with state and local health departments to enhance their capacity to monitor and test for resistant gonorrhea infections and developing rapid response strategies if resistance to the last line of antibiotics is detected.
More than 800,000 gonorrhea infections are estimated to occur in this country each year, but fewer than half are diagnosed. In recent years there has been an increase in the number of men diagnosed with this STD. Although some men and women may have symptoms (such as a burning sensation when urinating, or green or whitish discharge) most people do not. As a result, many infections go undetected and untreated. Left untreated, gonorrhea can cause serious health problems, particularly for women, including chronic pelvic pain, life-threatening ectopic pregnancy, and even infertility. Infection also increases the risk of contracting and transmitting HIV.