GONORRHEA: Increasing Resistance to Top Two Treatment Options

Federal officials announced yesterday that strains of gonorrhea in Hawaii and Missouri have exhibited rapidly increasing resistance to commonly prescribed antibiotics, limiting the options for treatment of the STD, the New York Times reports. Nearly 10% of Hawaii cases were found to be resistant to an antibiotic considered the "standard treatment" for gonorrhea -- ciprofloxacin, commonly known as Cipro. The resistance rate is up from 1.4% just two years ago. In Kansas City, Mo., the first reported cohort of people with resistant infections, including 12 heterosexual men, were found to be resistant to a different antibiotic, azithromycin, commonly known as Zithromax. In response to these reports, the CDC issued new recommendations for gonorrhea treatment, including cefixime, commonly known as Suprax, ceftriaxone, commonly known as Rocephin, or injections of spectinomycin. Unfortunately, ciprofloxacin and other fluoroquinolones that are now proving obsolete to resistant strains are preferred treatment options because they are inexpensive pills. Dr. Susan Wang, epidemiologist with the CDC, said that doctors also will now have to rely on injectable antibiotics, which are more expensive. Untreated gonorrhea can cause infertility, ectopic pregnancy and chronic pelvic pain and can facilitate HIV transmission. The CDC has also advised patients to "discuss recent travels with their doctors when gonorrhea was suspected." Doctors are being advised to ask patients or their sex partners who might have gonorrhea if they could have acquired the infection in Hawaii, other Pacific Islands, or Asia -- where a high level of resistance to fluoroquinolones has developed (Altman, New York Times, 9/22). Researchers believe the resistant Hawaii strains may have arrived from Asia. Other theories on the development of resistant strains point to an aggressive campaign against chlamydia, the most prevalent STD in the United States and also commonly treated with azithromycin. The dose of this antibiotic prescribed for killing chlamydia bacteria is not high enough to kill gonorrhea, enabling the latter bacteria to become resistant to the drug in people who have both infections. Throughout the chlamydia campaign, patients were often tested for chlamydia, but not gonorrhea, even though the two STDs often travel together. The Washington Post reports that the "main hazard of drug resistance is that it increases the number of persistent cases, which promotes spread of the disease." Wang said, "Drug resistance has historically been a problem with gonorrhea, starting from penicillin and sulfanilamide [in the 1930s and 1940s]. In the last few years, we sort of forgot about it because we had effective drugs. This is a wake-up call that the problem has continued to exist, and we need to pay more attention to it" (Brown, Washington Post, 9/22). Other researchers are concerned that the resistant strains will spread from Asia and Hawaii to the mainland United States. Gonorrhea is the second most prevalent STD in the United States, with more than 320,000 cases reported to the CDC in 1997 (Patten-Hitt, Reuters Health, 9/21).