Preparing for an era of untreatable gonorrhea

Abstract

Purpose of Review The proportion of Neisseria gonorrhoeae isolates with reduced susceptibility to extended-spectrum cephalosporins (ESC) has increased rapidly since 2006. Clinicians, researchers and public health officials need to be prepared for the possibility of an era of untreatable gonorrhea. This review focuses on the evidence for current gonorrhea treatment recommendations, potential future treatment options, and other methods to control gonorrhea. Recent Findings In addition to an increased in isolates with decreased susceptibility to ESCs, there have been reported treatment failure to both cefixime and ceftriaxone. In response, some countries have increased the recommended cephalosporin dose, and most now recommend dual-therapy with an ESC and azithromycin. The pharynx has been implicated as a site for acquiring resistance through transformation with commensal Neisseria species or induced resistance through subtherapeutic antimicrobial levels. Thus, appropriate screening of the pharynx and treatment with a regimen which eradicates gonorrhea from the pharynx is necessary. At present, several studies are evaluating various novel treatment regimens in preparation for an era of untreatable gonorrhea. Summary Screening for asymptomatic infections, maintaining culture capacity to monitor antimicrobial resistance, treating with ceftriaxone plus azithromycin, and ensuring that all sexual partners are treated, are among the best strategies to control gonorrhea in the current clime.

Incidence of repeat testing and diagnoses ofChlamydia trachomatisandNeisseria gonorrhoeain swingers, homosexual and heterosexual men and women at two large Dutch STI clinics, 2006–2013

“…Obviously, a restricted testing capacity also would leave care opportunities missed and STI undetected. Particularly for undetected NG, the consequences (ie, extragenital infections, potential treatment resistance, morbidity, further spread) cannot be underestimated 18. Also, we occasionally saw cases of HIV and syphilis.…”

Aminomethyl spectinomycins as therapeutics for drug-resistant respiratory tract and sexually transmitted bacterial infections

“…However, isolates resistant to all available treatments including the cephalosporin ceftriaxone have recently arisen and now pose a tremendous threat to public health worldwide (25, 26). This underscores the dire need for new treatments for this sexually transmitted disease (STD).…”

Changing Antimicrobial Resistance Profiles among Neisseria gonorrhoeae Isolates in Italy, 2003 to 2012

“…A major challenge in the control of N. gonorrhoeae infections is the spread of isolates that show resistance to antimicrobial agents (3,4). In particular, gonococci resistant to third-generation cephalosporins have been reported in Japan, France, and Spain (5,6,7,8), and the emergence of isolates exhibiting resistance to a broad range of antimicrobial agents has led some to assign the status of "superbug" to N. gonorrhoeae (9,10).…”