Bisher AKIL, MD

Resistant Gonorrhea

In General Health on July 21, 2011 at 12:22 am

Recent reports from the West Coast and from Japan described a new strains gonococci (gonorrhea, GC) and that is a concern. Here is a summary and update. The current recommendations for treating Neisseria gonorrhoeaeinfection involve the use of a cephalosporin plus either azithromycin or doxycycline. In May 2011, the CDC reported the isolation of azithromycin-resistant gonococci from five male patients at a sexually transmitted disease (STD) clinic in California. Then earlier this month, a report presented at a meeting of the International Society for Sexually Transmitted Diseases Research in Quebec City, described a
strain of N. gonorrhoeae highly resistant to ceftriaxone . The organism was discovered in samples from Kyoto, Japan[ Ohnishi M et al. The new superbug Neisseria gonorrhoeaemakes gonorrhoea untreatable? — First high-level ceftriaxone resistance worldwide and public health importance. 19th Biennial Conference of the International Society for Sexually Transmitted Diseases Research, Quebec City, Canada, July 2011. Abstract O3-S4.01] The strain shows four- to eightfold higher levels of resistance to ceftriaxone than any previously described isolate, according to the meeting abstract. The organism is also resistant to “all other cephalosporins, as well as most other antimicrobials tested.”The strain’s resistance to ceftriaxone, the last line of defense against treatment failures in the disease, represents “a large public health problem,” the abstract says. It continues: “The era of untreatable gonorrhea may now have been initiated.” – Now, the CDC urges confirmation of treatment success, especially in MSM in the western U.S., by having patients return for testing (preferably with culture) 1 week after treatment. Patients with cefixime treatment failure should be retreated with 250 mg of ceftriaxone intramuscularly and 2 g of azithromycin orally. In cases involving ceftriaxone treatment failure, an infectious diseases expert and the CDC should be consulted. All isolates with decreased cefixime or ceftriaxone should be reported to local or state health departments and, ultimately, to the CDC ( Source: [Centers for Disease Control and Prevention (CDC). Cephalosporin susceptibility among Neisseria gonorrhoeaeisolates — United States, 2000–2010. MMWR Morb Mortal Wkly Rep 2011 Jul 8; 60:873.] _ Comments: Confirmation of the infection (cultures) should be obtained when GC is suspected, then proper treatment as described above need be given, then a repeat of the culture, now that we have this serious threat. Treaters should not cut-corners .BA

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