U. WASHINGTON (US) — Scientists are issuing an urgent call to action to halt the growing threat of drug-resistant gonorrhea in the United States.
In July of 2011, a U.S. Centers for Disease Control and Prevention study signaled the potential for resistance to the cephalosporins, the last line of defense for treating gonorrhea.
“It is time to sound the alarm,” says Judith N. Wasserheit, professor and vice chair of the department of global health at the University of Washington. and co-author of a new perspective published in the New England Journal of Medicine.
“Though there is no evidence yet of treatment failures in the United States, trends in decreased susceptibility coupled with a history of emerging resistance and reported treatment failures in other countries point to a likelihood of failures on the horizon and a need for urgent action.”
Gonorrhea is the second most commonly reported communicable disease in the United States, with an estimated incidence of more than 600,000 cases annually. It disproportionately affects some populations such as minorities who are marginalized because of race, ethnic group, or sexual orientation.
Scientists note that Neisseria gonorrhoeae has always readily developed resistance to antimicrobial agents: It became resistant to sulfanilamide in the 1940s, penicillins and tetracyclines in the 1980s, and fluoroquinolones by 2007. The treatment options recommended by the CDC are now limited to third-generation cephalosporins.
But the effectiveness of cephalosporins for treating gonorrhea has been decreasing rapidly. Through CDC’s Gonococcal Isolate Surveillance Project , researchers are seeing a 17-fold increase in elevated minimum inhibitory concentrations (MICs)—a measure of drug susceptibility. MICs for oral cefixime went from 0.1 percent in 2006 to 1.7 percent in the first six months of 2011.
In the past, when the prevalence of antimicrobial resistance in the Gonococcal Isolate Surveillance Project exceeded 5 percent, national treatment recommendations were changed to focus on other effective drugs. But currently, there are no other drugs.
The most prominent increases in drug susceptibility to gonorrhea continue to be among men who have sex with men, and in the West. These geographic and demographic patterns are worrisome because they mirror those observed during the emergence of fluoroquinolone-resistant N. gonorrhoeae.
Scientists are calling on a collective effort from physicians, drug companies, and health care providers to help stop the emergence and spread of resistant gonorrhea.
“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,” the scientists write.
Researchers from the University of North Carolina at Chapel Hill and the Division of STD Prevention at the Centers for Disease Control and Prevention contributed to the study.
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