Drug-Resistant Gonorrhea on the Rise
Increase in Antibiotic-Resistant Gonorrhea Cases Prompts New Treatment
April 29, 2004 -- A dramatic increase in the number of
antibiotic-resistant gonorrhea cases in the U.S. has prompted the CDC to issue
new gonorrhea treatment guidelines for gay and bisexual men.
A new CDC study of men seen at sexually transmitted disease
(STD) clinics in 23 U.S. cities shows the number of gonorrhea cases resistant
to the group of antibiotics most commonly used to treat the disease more than
doubled from 2002 to 2003, from 0.4% to 0.9%. These antibiotics are known as
fluoroquinolones and include ciprofloxacin, ofloxacin, and levofloxacin. These
antibiotics are inexpensive and can be given as a single oral dose to treat the
Antibiotic-resistant gonorrhea was 12 times higher among men
who have sex with men than among heterosexual men. The number of resistant
gonorrhea cases nearly tripled among this group, from 1.8% in 2002 to 4.9% in
2003 compared with rates of 0.2% and 0.4% among heterosexual men during the
same time period.
Gonorrhea is caused by bacteria that invade the mucous
membranes of the genitals and urinary tract. Gonorrhea infection can facilitate
transmission of HIV.
"The data shows that the prevalence of
fluoroquinolone-resistant gonorrhea among [men who have sex with men]
nationally is now approximately 5%. This level of resistance is often used at
the level at which a therapeutic regimen should be changed," says John
Douglas, MD, director of the CDC's STD prevention program.
"For this reason, the CDC is now recommending that that
fluoroquinolones no longer be used as a first-line treatment for gonorrhea
among [men who have sex with men] anywhere in United States," says
No changes in antibiotic treatment for gonorrhea infection are
recommended for other groups. But fluoroquinolones also should not be used to
treat patients whose gonorrhea was acquired in Asia, the Pacific islands
(including Hawaii), California, and other areas that are known to have higher
rates of antibiotic-resistant gonorrhea.
New Treatment Recommendations for Gay and Bisexual Men
Kenneth Mayer, MD, medical research director at the Fenway
Community Health in Boston, says fluoroquinolones are commonly used to treat
uncomplicated cases of gonorrhea because they are inexpensive and easy to use
since they are taken as pills.
But under the new CDC recommendations, gay and bisexual men
should be treated with one of two injectable antibiotics, ceftiaxone or
spectinomycin, depending on the type and location of infection. The liquid form
of the antibiotic cefixime may also be another option.
Douglas says many factors may be contributing to the rise of
drug-resistant gonorrhea cases in the U.S., such as relaxed safe sex behaviors,
use of shared needles for crystal methamphetamine drug use,
and increased anonymous sex through use of the Internet. In addition,
international travel to areas where drug-resistant gonorrhea is more prevalent,
such as Asia, may have also contributed to the spread in the U.S.
CDC officials say they are concerned about rising rates of
risky sexual behavior and now the rising rates of drug-resistant gonorrhea
infections. They say they plan to continue to closely monitor infection rates
among both the homosexual and heterosexual communities.