Gonorrhea is becoming more and more drug resistant, UK authorities are warning. The Health Protection Agency, UK, says it will no longer recommend cefixime as the first choice of treatment because laboratory tests show it is becoming increasingly less effective. The Agency says there have been reports of treatment failure in patients on cefixime.

Cefixime has been the most widely used antibiotic to treat gonorrhea during the last ten years.

The HPA (Health Protection Agency) is now recommending doctors use a combination of ceftriaxone by injection along with oral azithromycin. Ceftriaxone is a much more powerful antibiotic than cefixime.

The HPA's annual Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) published on Monday, 10th October, reports that laboratory tests on bacterial samples taken from infected patients and grown in the lab in 2010 revealed reduced susceptibility to cefixime in 17.4% of cases, a huge increase from 10.6% in 2009. In 2005 the figure was 0%.

For the last seven decades, ever since penicillin became available, gonorrhea has been a fairly straightforward infection to treat effectively. However, Neisseria gonorrhoeae, the bacterium that causes the infection, is exceptionally adaptable and has become progressively resistant, or less susceptible to an ever-growing range of antibiotics. First penicillin fell by the wayside, then tetracyclines, followed by ciprofloxacin, and today cefixime seems to be going the same way.

According to WHO (World Health Organization), when treatment failure reaches 5%, the first-line antibiotic used should be changed. Because of the alarming rise in reduced susceptibility in lab tests, the cefixime change recommended by the HPA is being issued pre-emptively. Reduced susceptibility is an early indicator of growing resistance.

HPA gonorrhea expert, Professor Cathy Ison, said:

"Our lab tests have shown a dramatic reduction in the sensitivity of the drug we were using as the main treatment for gonorrhoea. This presents the very real threat of untreatable gonorrhoea in the future.

We were so worried by the results we were seeing that we recommended that guidelines on the treatment of gonorrhoea were revised in May this year, to recommend a more effective drug. But this won't solve the problem, as history tells us that resistance to this therapy will develop too. In the absence of any new alternative treatments for when this happens, we will face a situation where gonorrhoea cannot be cured.

Many patients may feel anxious about having an injection, but this is now the best way of avoiding treatment failure. Patients who refuse the jab will be offered oral antibiotics instead.

This highlights the importance of practising safe sex, as, if new antibiotic treatments can't be found, this will be only way of controlling this infection in the future."

Gonorrhea is the second most common bacterial sexually transmitted infection in the United Kingdom and the USA, after Chlamydia.

Written by Christian Nordqvist