Emerging Drug-Resistant Gonorrhea: What's New and What Now?

Gail Bolan, MD


March 06, 2017

Editorial Collaboration

Medscape &

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Hello. I am Dr Gail Bolan, director for the Division of STD Prevention at the Centers for Disease Control and Prevention. Today, as part of the CDC Expert Commentary series on Medscape, I will provide the latest developments in drug-resistant gonorrhea and, most important, the critical steps you can take to protect your patients and keep emerging resistance at bay.

Gonorrhea is very common in the United States. In 2015, nearly 400,000 cases were reported to CDC.[1] However, we know that not all cases are reported and we estimate that there are approximately 800,000 infections each year. Many infections go undetected because the patients are asymptomatic and therefore are not tested. Untreated gonorrhea can cause serious reproductive health problems for women, including conditions that can lead to infertility. It can also increase the risk of getting or giving HIV.

Gonorrhea can be cured with antibiotics, but drug resistance is making the infection harder and harder to treat. A decade ago, CDC recommended five treatment options for gonorrhea. Today we're down to one: dual therapy with an injection of ceftriaxone and an oral dose of azithromycin.[2] And yet, new data suggest that gonorrhea is beginning to outsmart this last treatment as well. In July [2016], an analysis of gonorrhea specimens from a CDC sentinel surveillance program indicated that resistance to azithromycin may be emerging.[3]

Separately, and for the first time in the United States, health officials identified a cluster of gonorrhea infections in Hawaii that are showing potential emerging resistance to ceftriaxone and very high-level resistance to azithromycin. All patients were successfully treated using the recommended dual regimen; however, both the resistance pattern and the fact that it was a cluster of cases (which means the strain was able to spread) are causes for concern.[4]

Dual therapy with these two drugs is still highly effective, but we can't protect this last line of defense without your help. In fact, not following the recommended treatment could accelerate emerging resistance. Providers should take the following actions to ensure effective treatment:

  • Follow and stay up-to-date with any changes to CDC's treatment guidelines.

  • If concerned about a treatment failure, a test of cure, performed 1-2 weeks after treatment, can be considered on a case-by-case basis.

  • Report possible treatment failures to your local health department's STD program.

  • When your patient is diagnosed with gonorrhea, notify and treat their sexual partners to prevent reinfection and stop the spread of gonorrhea. Expedited partner therapy is allowable by law in most states.

Providers should continue to follow the basic tenets of good STD prevention. Take sexual histories and screen patients to avoid the complications and stop the spread of gonorrhea. Screen all sexually active women under 25 years of age, as well as older women with risk factors. And screen sexually active men who have sex with men at anatomic sites of possible exposure at least once a year.

Thank you for keeping this issue a priority and for helping keep untreatable gonorrhea from becoming a reality.