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Photomicrograph of a sample from a male with urethritis that was found to be positive for the presence of Neisseria gonorrhoeae. Photo: CDC Public Health Image Library
February 9, 2012 - Infectious disease experts , including the University of North Carolina School of Medicine, warn of the growing threat of multi-drug resistant gonorrhea in the United States, according to a perspective in the Feb. 9 issue of the New England Journal of Medicine.
Last July, the U.S. Centers for Disease Control and Prevention released a report which pointed to the potential for resistance to cephalosporins, the class of antibiotics which are the last line of defense against gonorrhea.
"This is a serious problem," said P. Frederick Sparling, a professor of medicine at UNC who co-authored the article. “Trends to decreased susceptibility coupled with a history of emerging resistance and reported treatment failures in other countries point to a need for action right now.”
The authors, which also include Gail A. Bolan, director of the Division of STD Prevention at the Centers for Disease Control and Prevention in Atlanta, and Judith N. Wasserheit, vice chair of the Department of Global Health at the University of Washington, issue an urgent call to action to halt the continued increases in drug-resistant gonorrhea.
Gonorrhea is the second most commonly reported communicable disease in the United States, with an estimated 600,000 cases annually.
Researchers note that gonorrhea has always readily developed resistance to antimicrobial agents: it became resistant to sulfanilamide in the 1940s, penicillins and tetracyclines in the 1980s, and fluoroquinolones by 2007. The treatment options recommended by the CDC are now limited to third-generation cephalosporins.
But the effectiveness of cephalosporins for treating gonorrhea has been decreasing rapidly. In a CDC surveillance project , researchers have seen a 17-fold increase in the prevalence of gonococcal strains with resistance to cephalosporins. Nearly 2% of isolates are now resistant to cefixime, the most commonly prescribed cephalosporin.
Generally, when the prevalence of antimicrobial resistance exceeds 5 percent, national treatment recommendations are changed to focus on other effective drugs. But currently, there are no other drugs.
Scientists are calling on a collective effort from physicians, drug companies, and health care providers to help stop the emergence and spread of resistant gonorrhea.
“Investing in rebuilding our defenses against gonococcal infections now, with involvement of the health care, public health, and research communities, is paramount if we are to control the spread and reduce the consequences of cephalosporin-resistant strains,” researchers wrote.
Sparling is also director of the Southeast Regional Center of Excellence for Emerging Infections and Biodefense and the North Carolina Sexually Transmitted Diseases Cooperative Research Center.