Drugs Losing Efficacy Against Gonorrhea

By Rob Stein
Washington Post Staff Writer
Friday, April 13, 2007

Antibiotic-resistant gonorrhea is spreading rapidly across the United States, federal health officials reported yesterday, raising alarm about doctors' ability to treat the common sexually transmitted infection.

New data from 26 U.S. cities show the number of resistant gonorrhea cases is rising dramatically, jumping from less than 1 percent of all gonorrhea cases to more than 13 percent in less than five years, the Atlanta-based Centers for Disease Control and Prevention reported.

In response, the CDC advised doctors treating gonorrhea to immediately stop using ciprofloxacin, marketed as Cipro, and other antibiotics in its class, which have been the first line of defense against the disease, and resort to an older class of drugs to ensure patients are cured and do not spread the stubborn infection.

"We've lost the ability to use what had been the most reliable class of antibiotics," said John M. Douglas Jr., who heads the CDC's division of sexually transmitted disease prevention. "This is necessary to protect both public and private health."

The development is alarming, Douglas and other experts said, because gonorrhea tends to develop resistance to antibiotics quickly, and doctors will be powerless to treat it if that happens with the remaining class of drugs.

"We still have one effective class, but now it's the only one we've got," Douglas said. "This raises the possibility that we may slip into a situation where we have no highly reliable remedies."

The emergence of resistant gonorrhea marks the latest common pathogen to have shifted from an easily treated infection to a resistant form that is suddenly far more dangerous.

"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Henry Masur, president of the Infectious Disease Society of America.

Gonorrhea's resistance was probably caused by the same problem that led to resistance of other organisms -- the casual use of antibiotics in the United States and overseas, which causes pathogens to mutate, Douglas and others said.

"People will take these drugs for many reasons, like if they just have a cold, stimulating resistance to bacteria they don't know they have," Douglas said.

The emergence of resistant gonorrhea and other disease-causing agents comes as efforts to develop new antibiotics are flagging because of a lack of interest by the pharmaceutical industry, he noted.

"We'll have a major problem on our hands if we don't develop new antibiotics," Douglas said.

Gonorrhea is the second-most-common sexually transmitted disease in the United States after chlamydia, infecting more than 700,000 Americans each year. The highest reported rates occur among sexually active teenagers, young adults and African Americans. If untreated, the disease -- which usually does not produce symptoms until the later stages -- can lead to sterility and potentially life-threatening complications.

Resistant strains of the bacteria that cause gonorrhea were first detected in Asia. Resistant gonorrhea then apparently spread to Hawaii and California, before emerging elsewhere around the United States, first among gay men. In response, the CDC recommended doctors stop using Cipro and other drugs in its class, known as fluoroquinolones, to treat gonorrhea in California and Hawaii, and among gay men nationwide.

The agency expanded that recommendation to everyone nationwide after detecting a sharp rise in resistant gonorrhea among heterosexual males. The rate increased from 0.6 percent of all cases in 2001 to 6.7 percent in the first half of 2006 -- an 11-fold increase. The resistance appears to be widespread around the country, with particularly sharp increases occurring in some cities. In Philadelphia, the rate jumped from 1.2 to 26.6 percent. In Miami, it increased from 2.1 percent to 15.3 percent. At the same time the rate continued to rise rapidly among gay men, increasing from 1.6 percent to 38 percent of all cases.

The news comes as the rate of new gonorrhea infections has started rising in some Western states. Public health experts warned that the recommendation to change the standard care will make it more difficult to stem the spread of the disease because the main weapon is to diagnose and treat patients quickly before they can infect someone else.

The CDC is recommending doctors use a class of antibiotics known as cephalosporins, in particular the drug ceftriaxone, which is given by injection, making its use more painful and complicated. Many doctors do not typically stock the shots. And patients who are allergic to penicillin often cannot use the drugs.

While significant resistance to cephalosporins has not been detected, the agency is working with state and local health departments, as well as the World Health Organization, to monitor the possible emergence of resistance to that class.

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