CDC calls for gonorrhea treatment changes
by Bob Roehr
The spread of drug-resistant gonorrhea has prompted the Centers for Disease Control and Prevention to change the nationwide guidelines for treating that infection. The announcement came in an April 12 conference call with reporters.
But gay men and residents of Hawaii and California will see no changes. That's because they were ahead of the curve, experiencing some of the first incidence of drug resistance. Treatment recommendations were changed for them in 2004, 2000, and 2002 respectively.
Gonorrhea is the second most common sexually transmitted disease in the United States, with an estimated 700,000 new infections a year, many of which are not diagnosed. If left untreated, it can lead to sterility, or to birth defects in a developing fetus. The associated inflammation puts a person at greater risk for becoming infected with HIV and increases the risk that a person who already has HIV will pass it on to a sexual partner.
Over the years the bacteria has developed resistance to penicillin, tetracycline, and now the flouroquinolone class, which has been the drug of choice for treating gonorrhea since 1993.
But resistance to fluoroquinolones has grown steadily among heterosexual men, from 0.6 percent of sample cases in 2001 to 6.7 percent of sample cases in 2006, according to a study published in Morbidity and Mortality Weekly Report. It is based on data gathered annually from 26 cities by the CDC.
Resistance was seen in a quarter or more of all samples from Philadelphia, San Diego, and Honolulu, while it remained in the single digits in much of the South and Midwest.
The new treatment recommendation is that all patients infected with gonorrhea receive a single injection of ceftriaxone, a drug in the cephalosporin class of antibiotics. CDC is working with a manufacturer to produce a pill form of ceftriaxone, said John M. Douglas Jr. director of the Division of Sexually Transmitted Disease Prevention.
Douglas said that at first glace it might make sense to tailor their recommendations to allow regions with low incidence of resistance to use the older guidelines, however, their surveillance generally comes only from STD clinics and it is difficult to tell how representative that is of an entire region. Furthermore, resistance quickly reached high levels in Philadelphia and Miami, over two years or less.
"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Dr. Henry Masur, a physician at the National Institutes of Health and president of the Infectious Disease Society of America. He warned, "Unless we develop more incentives for drug development, we will soon return to the pre-antibiotic era when acquiring a bacterial infection was often a death sentence."
"The Bush administration's response to STDs in the United States has ranged from apathetic to actively harmful," said Sean Barry, director of prevention policy with the national Community HIV/AIDS Mobilization Project. "This data is yet another wake-up call that the federal budget for STDs has been neglected for too long."
CHAMP is calling for increased funding for CDC, an unmuzzling of prevention efforts that prohibit honest talk about sexual practices, and an end to funding for ineffective abstinence-only-until-marriage programs.