Antibiotic Resistant Gonorrhea?

Is it true that gonorrhea is no longer curable with antibiotics? I heard that this is true in Britain and wonder what’s going on in the U.S.

– April 26, 2016

The issue you raise concerns Neisseria gonorrhoeae, the bacteria that cause this sexually transmitted disease, which appears to be increasingly resistant to the antibiotics used to treat it.

In December 2015, Dame Sally Davis, England’s chief medical officer wrote to general practitioners and pharmacies, warning that gonorrhea is at risk of becoming an untreatable disease. In September 2015, an outbreak of highly drug-resistant gonorrhea occurred in the north of England. The cases were described as “super gonorrhea,” since they didn’t respond to azithromycin, the drug most commonly used.

This is very concerning. Untreated or incompletely cured gonorrhea can lead to infertility, pelvic inflammatory disease (which can be life-threatening) and blindness in newborns if pregnant women are infected. The most common symptoms in men typically appear 2 to 5 days after exposure: a burning sensation when urinating; a white, yellow or green discharge from the penis; and sometimes, painful or swollen testicles. In women, symptoms tend to be mild and similar to those of a bladder or vaginal infection: a painful or burning sensation during urination, increased vaginal discharge or vaginal bleeding between periods. However, the more serious consequences of gonorrhea can occur whether or not symptoms appear following exposure.

The danger of antibiotic-resistant gonorrhea has been well publicized in Britain, but Dame Sally’s letter was prompted by a study showing that some doctors were still prescribing antibiotics that no longer work, raising the risk that drug-resistant cases will spread.

In the U.S., a study published in 2015 found that an improvement in the response of gonorrhea to the antibiotic cefixime (Suprax) over the past few years seems to have reversed, suggesting that infections may now be less susceptible to the drug. The CDC follows trends in responsiveness of bacteria to antibiotics here and abroad and updates its recommendations when it learns that current treatments are no longer working well. At present, the agency recommends a combination of drugs, including ceftriaxone (Rocephin) plus another antibiotic.

Antibiotic resistance stems in part from the natural ability of microbes to evolve defenses in order to survive. But overprescription and improper use of these medications also plays a significant role. According to the Infectious Disease Society of America, up to half of antibiotic use is unnecessary or inappropriate. We urgently need new and better antibiotics to stem the emerging public health crisis posed by growing resistance to current drugs. But we also have to be much more prudent about how we use them.

Andrew Weil, M.D.

Ben Quinn, “Gonorrhea could become untreatable, says chief medic”, The Guardian, December 27, 2015, accessed December 26, 2015

Robert D. Kirkcaldy et al, “Trends in Neisseria gonorrhoeae Susceptibility to Cephalosporins in the United States, 2006-2014.” JAMA November 3, 2015, doi: 10.1001/jama.2015.10347.

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