Over the last three years, gonorrhea has become increasingly harder to treat with antibiotics, making it now a reality that perhaps we may be facing a gonorrhea strain for which no current medications would be effective, researchers from the CDC (Centers for Disease Control and Prevention), and the University of North Carolina School of Medicine reported in NEJM (New England Journal of Medicine).

The authors explain that approximately 600,000 people are diagnosed with gonorrhea in the USA every year. It is now the second most commonly reported communicable disease in the country.

A disproportionate number of people from ethnic and racial minorities are affected by gonorrhea.

Ever since the first half of the last century, scientists have been battling against the drug-resistance progress achieved by Neisseria gonorrhoeae, the bacterium that causes the illness gonorrhea. In the 1940s it became resistant to sulfanilamide, then decades later penicillins lost their effect, and after that tetracyclines.

In July 2011, the CDC published a report indicating that gonorrhea was starting to show signs of resistance to cephalosporins; our last line of defense against the disease - all we have left are third-generation cephalosporins.

Co-author, P. Frederick Sparling, said:

"This is a serious problem. 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 say the continued increase in drug-resistant gonorrhea must be halted.

According to the CDC, the number of reported Gonococcal strains with cephalosporin resistance has increase dramatically over the last three years. An alarming proportion of gonorrhea cases today in the USA include isolates that are resistant to the most commonly prescribed cephalosporin - cefixime.

In a report last June, the CDC wrote:

"During 2009--2010, 13 (0.11%) of 11,323 isolates had decreased susceptibility to cefixime (MICs = 0.5 µg/mL), compared with seven (0.02%) of 41,462 isolates during 2000--2006 (p<0.001) (isolates were not tested for cefixime susceptibility during 2007--2008).

All 2009--2010 isolates with decreased susceptibility to cefixime were resistant to tetracycline and ciprofloxacin, all but one were resistant to penicillin, and none exhibited decreased susceptibility to azithromycin (≥2 µg/mL).

Twelve of the men from whom the isolates were obtained were MSM (men who have sex with men); 10 men resided in the West, and three in the Midwest. No isolates had decreased susceptibility to ceftriaxone during 2000--2010."

Health authorities generally recommend changing the focus to other effective medications when antimicrobial resistance goes over 5% of reported cases. The problem with gonorrhea is that we have nothing to replace cephalosporins.

The authors say that in order to stop the spread of resistant strains of gonorrhea, a committed, collective effort is required by health care providers, drug manufacturers and doctors.

They wrote:

"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."

Written by Christian Nordqvist