Treatments Continue to Fail Against This Common STD

Treatments Continue to Fail Against This Common STD

New guidelines emerge to combat antibiotic resistant gonorrhea.

Although currently curable, gonorrhea may be becoming more difficult to treat. According to an August 2018 report from the Centers for Disease Control and Prevention (CDC), the number of reported gonorrhea cases increased by 67 percent from 2013 to 2017. And, the CDC expects that the infection is eventually going to become immune to the last highly effective antibiotic treatment. 

The World Health Organization (WHO) has suggested that the decrease in condom usage and increased urbanization and travel are contributing to this gonorrhea surge.

Based on a study of over 5,000 samples in 2014, the CDC found that the bacteria that causes gonorrhea, Neisseria gonorrhoeae, was becoming increasingly resistant to a variety of antibiotics, including tetracycline, ciprofloxacin and penicillin. Notably, there was an increase in resistance to the antibiotics used to treat gonorrhea, azithromycin and ceftriaxone. The more recent study from the CDC reports that during laboratory testing, the resistance to azithromycin increased from 1 percent in 2013 to more than 4 percent in 2017. But, emerging resistance to ceftriaxone hasn’t been observed since the dual therapy went into effect. 

And while the US has not yet experienced a strain completely resistant to the combination of azithromycin and ceftriaxone, they have been reported in the United Kingdom and Australia.  

What is gonorrhea?
Gonorrhea is a sexually transmitted bacterial infection that can affect both men and women. The bacteria can infect the throat, rectum and urethra, and in women, can infect the cervix. In some cases, pregnant women can pass the infection to their baby during birth. Gonorrhea can cause pain during urination and discharge from the penis or vagina, but it's often asymptomatic, especially in women. 

How common is gonorrhea?
In 2014, over 350,000 cases of gonorrhea were reported to the CDC. According to the CDC, though gonorrhea is most common in young people aged 15 to 24, anyone who is having unprotected sex is at risk for contracting the infection. To reduce risk for contracting gonorrhea during sex, the CDC recommends using latex condoms.

What do these results mean?
As the Neisseria gonorrhoeae bacteria become more resistant to antibiotics, they become harder to treat and can potentially become untreatable. Without treatment, gonorrhea can cause pain in the pelvis and abdomen, ectopic pregnancy and infertility issues in both men and women. 

New treatment guidelines for gonorrhea
With the increase of antibiotic-resistant cases of gonorrhea, both the WHO and the CDC have released a new set of treatment guidelines. In 2007, the CDC said the use of cephalosporins was the only remaining recommended treatment, but have since modified the recommendation to include azithromycin, another antibiotic. The WHO found that 81 percent of countries reported increasing bacterial resistance to azithromycin, and 66 percent are seeing more strains resistant to cephalosporin. This new, dual therapy regimen uses injectable cephalosporin in conjunction with oral azithromycin in order to optimize treatment for gonorrhea while preventing further development of antibiotic resistance.  

Teodora Wi, MD, medical officer at the WHO’s Department of Reproductive Health and Research says experts are banking on this dual therapy to control gonorrhea, but the WHO expects guidelines will change as resistance rates continue to rise.

Medically reviewed in January 2019.

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