Gonorrhea is Changing

Gonorrhea has begun to develop a resistance to cephalosporins alone

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The bacteria responsible for the sexually transmitted infection, gonorrhea, can develop a tolerance for certain antibiotics. New recommendations involve a two-pronged approach.

A recent study from the Centers for Disease Control and Prevention (CDC) suggested that gonorrhea has started developing a resistance to treatment.

The CDC recommends using two different kinds of antibiotics, one injection and one oral for treatment.

"Use a condom."

The Gonococcal Isolate Surveillance Project (GISP) collected data from U.S. laboratory results from 2006-2011. GISP has been tracking N. gonorrhoeae since 1986. Based on the GISP findings the CDC has a new recommendation for the treatment of gonorrhea.

The old treatment was an injection of ceftriaxone alone, dosage varied on the patient.

The new treatment is a combination of a 250mg injection of ceftriaxone one of two oral antibiotics: azithromycin, a one-time, 1g dose, or 100mg of doxycycline, twice daily for seven days.

In 2011 over 300,000 cases of gonorrhea were reported in the U.S., making it the second most common sexually transmitted infection.

Ignoring gonorrhea can result in pelvic inflammatory disease, infertility, ectopic pregnancy and make a person more susceptible to HIV transmissions.

The bacteria N. gonorrhoeae can build up a tolerance to antibiotics. Prior to 2007 gonorrhea was treated with fluoroquinolone, until a fluoroquinolone resistance made it an ineffective treatment.

Cefixamine is an oral version of ceftriaxone, they are both cephalosporins (a class of antibiotics). From 2006 to 2011 N. gonorrhoeae bacterial samples begin to show greater resistance to cefixamine, from 0.1 percent to as high as 17 percent in Hawaii.

For ceftriaxone, the resistance was 0.1 percent to 1 percent. The injected antibiotic can go straight into the blood stream and more effectively kill N. gonorrhoeae than the oral version.

Overuse and/or increasing the dose of cefixamine could render it a completely useless antibiotic in the future. It is no longer recommended as a treatment for gonorrhea by the CDC.

Using the injected ceftriaxone in combination with another class of antibiotics like doxycycline or azithromycin should delay a resistance to cephalosporins.

Authors said, “Treatment of patients with gonorrhea with the most effective therapy will limit the transmission of gonorrhea, prevent complications, and likely will slow emergence of resistance.”

“However, resistance to cephalosporins, including ceftriaxone, is expected to emerge. Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed.”

This report was made available on the Centers for Disease Control and Prevention website in August. This study was supported by the CDC, the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention and other state health agencies. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
August 16, 2012
Last Updated:
August 18, 2012