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CDC Shifts Gonorrhea Treatment Advice

Agency Drops Recommendation of Fluoroquinolone Antibiotics Because of Drug Resistance
By
WebMD Health News
Reviewed by Louise Chang, MD

April 12, 2007 -- The CDC announced today that it no longer recommends treating gonorrhea with fluoroquinolone antibiotics such as Cipro, Floxin, and Levaquin.

Instead, the CDC recommends only one class of drugs -- the cephalosporins, which are antibiotics such as Rocephin -- for gonorrhea treatment.

A rise in fluoroquinolone-resistant gonorrhea is the reason for the CDC's change in gonorrhea treatment recommendations.

New gonorrhea drugs are urgently needed, but none is in the drug development pipeline, the CDC's John Douglas Jr., MD, said in a news conference.

Douglas directs the CDC's Division of Sexually Transmitted Diseases Prevention.

Gonorrhea is a sexually transmitted disease. It's the second most commonly reported infectious disease in the U.S., with nearly 340,000 U.S. cases reported in 2005.

There may be twice as many gonorrhea cases in the U.S., since gonorrhea often goes undiagnosed and unreported, notes Douglas.

Drug-Resistant Gonorrhea

"Gonorrhea has proven to be quite efficient at navigating around the drugs we use to combat it, developing resistance first to penicillin, then tetracycline, and most recently to fluoroquinolones," Douglas says.

The CDC has recommended fluoroquinolones as a gonorrhea treatment option since 1993.

Douglas says the drugs were "highly effective" for several years, but fluoroquinolone-resistant gonorrhea has increased in recent years -- first in Hawaii, then California, and then nationwide among men who have sex with men.

"As a result, CDC recommended in 2000 and 2002 that fluoroquinolones not be used to treat gonorrhea infections acquired in Hawaii and California, respectively," Douglas says. "In 2004, we recommended that these no longer be used to treat men who have sex with men nationwide."

Now, the CDC is extending that recommendation to all gonorrhea cases nationwide.

The CDC bases its decision on preliminary 2006 data showing that fluoroquinolone-resistant gonorrhea is present nationwide and is continuing to rise among heterosexual men and among men who have sex with men.

The data come from gonorrhea cases reported among men in 26 U.S. cities.

In the first half of 2006, nearly 7% of gonorrhea cases in heterosexual men in those cities were resistant to fluoroquinolones. "That's an 11-fold increase from 0.6% in 2001," Douglas says.

In the first half of 2006, 38% of gonorrhea cases reported in those cities among men who have sex with men were fluoroquinolone-resistant, up from 1.6% in 2001.

New Drugs Needed

So far, there has been no sign that gonorrhea has learned how to resist cephalosporins. But that should be monitored, Douglas says.

"Although the cephalosporins offer several potential options for treating gonorrhea, the lack of additional classes of antibiotics is a serious concern," Douglas says.

"There are currently no new drugs for gonorrhea in the drug development pipeline," he says. "While we have not seen any significant resistance to cephalosporins to date, any emerging resistance would be a significant public health concern."

"Clearly, there is an urgent need for new effective medicines to treat gonorrhea, as we are running out of options to treat this serious disease. At the same time, increased vigilance in monitoring for resistance to remaining drugs is essential," Douglas says.

The new data and gonorrhea treatment recommendations appear in CDC's Morbidity and Mortality Weekly Report.

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