Gonorrhea Shows Increased Resistance to Cephalosporins

Gonorrhoea resistance to cefixime decreased by nearly 70% between 2011 and 2013, which suggested a halt in the drift toward resistance. Unfortunately, data from 2014 show the opposite and may indicate increases in resistance.

Gonorrhoea is a common sexually transmitted disease, and untreated gonorrhoea can cause complications to health in general and to reproductive health in particular. Unfortunately, gonorrhoea treatment has been jeopardized by antibiotic resistance. In 2012, the Centers for Disease Control and Prevention updated its guidelines to recommend ceftriaxone-based combination therapy as the only recommended therapy.

Robert D. Kirkcaldy, MD, MPH, from the CDC in Atlanta, Georgia, and colleagues published their resistance data in the November 3 issue of JAMA. The team sampled individuals from 34 sites participating in the CDC's Gonococcal Isolate Surveillance Project (GISP).

The GISP is a sentinel system that monitors urethral isolates from men with gonorrhoea to test for antimicrobial susceptibility. GISP was designed to detect emerging changes in susceptibility and is not nationally representative. Therefore, data from GISP may not represent resistance rates throughout the nation.

The investigators collected 51,144 isolates over the course of 6 years (2006 - 2014). Approximately one quarter of the isolates were taken from gay, bisexual, or other men who have sex with men.

The team analyzed susceptibility rates to third-generation cephalosporin antibiotics such as injectable ceftriaxone or oral cefixime.

Early samples initially showed an improvement in susceptibility that was temporally correlated with changes in CDC gonorrhoea treatment guidelines. Specifically, in 2013, the percentage of antibiotic resistant strains decreased to 0.4% from a high of 1.4% in 2011.

However, in 2014, 0.8% (95% confidence interval, 0.5% - 1.0%) of isolates were antibiotic-resistant.

The authors argue for a continued need to maintain surveillance and ensure that gonorrhoea is treated according to guidelines produced by the CDC. In addition, efforts should continue to search for new therapeutics.

One coauthor reported receiving grants from Becton Dickinson, Hologic, Roche Molecular, and Cempra; serving as a consultant for Rib-X (Melinta) and Cempra; receiving honoraria from Becton Dickinson, Roche Molecular, and Cepheid; and receiving royalties from McGraw-Hill. The other authors have disclosed no relevant financial relationships.

JAMA. 2015;314:1869-1871. Extract

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