Surveillance data show that gonorrhea isolates with decreased susceptibility to azithromycin, an indicator of emerging resistance, increased more than 400% between 2013 and 2014 (from 0.6% to 2.5% of gonorrhea isolates). 

This is a distressing sign that the future of current treatment options may be in jeopardy and underscores the importance of the federal government’s Combating Antibiotic Resistant Bacteria (CARB) Action Plan, according to a study published in the Centers for Disease Control and Prevention’s (CDC’s) Morbidity and Mortality Weekly Report.

“The confluence of emerging drug resistance and very limited alternative options for treatment creates a perfect storm for future gonorrhea treatment failure in the United States,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention said in a press release about the study. “History shows us that bacteria will find a way to outlast the antibiotics we’re using to treat it. We are running just one step ahead in order to preserve the remaining treatment option for as long as possible.”

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The combination therapy currently recommended by CDC – an oral dose of azithromycin and single shot of ceftriaxone. – still works. To date, no treatment failures have been reported in the United States. But signs of emerging resistance to azithromycin suggests that this drug will be next in the long line of antibiotics to which gonorrhea bacteria have become resistant – a list that includes penicillin, tetracycline, and fluoroquinolones. Because of gonorrhea’s ability to outsmart the antibiotics used to treat it, CDC has been closely monitoring early warning signs of resistance not only to azithromycin but also to cephalosporins, the class of antibiotics that includes ceftriaxone, the researchers wrote.

Gonorrhea is one of the most common STDs in the United States, and the 2014 STD surveillance report indicates that gonorrhea and other reportable STDs are on the rise.

CDC officials said they are taking action by collaborating with state and local health departments and community partner organizations to extend the reach of existing STD prevention services. This includes programs like Improving STD Programs through Assessment, Assurance, Policy Development and Prevention Strategies (STD AAPPS), which provides funding to all 50 states to decrease the burden of STDs, and Community Approaches to Reducing Sexually Transmitted Diseases (CARS), which leverages community resources and partners to reduce STD disparities.

As part of the broader CARB Action Plan, CDC officials are specifically addressing the threat of antibiotic resistant gonorrhea by working with state and local health departments to enhance their capacity to monitor and test for resistant gonorrhea infections and developing rapid response strategies if resistance to the last line of antibiotics is detected.

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1. CDC. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance —The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014MMWR. 2016; 65(7);1–19