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 infection.
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 Douglas.
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.