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Gonorrhea Becoming More Resistant to Antibiotic Cefixim, CDC Says

Other effective treatments remain available, but experts say the finding is cause for concern

One of several antibiotic treatment options (Cefixim) for the sexually transmitted disease gonorrhea seems to be losing its effectiveness, U.S. health officials warn in a new report.

According to HealthDay, the latest tracking by the Centers for Disease Control and Prevention (CDC) suggests that although resistance to the antibiotic treatment cefixime went down between 2011 and 2013, it started to creep back up in 2014.

The good news is that cefixime isn't usually the first drug of choice for treating gonorrhea infections. The CDC's most recent guidelines for gonorrhea treatment (issued in 2012) recommend using cefixime only when the preferred option — ceftriaxone-based combination therapy — isn't available. And the CDC's new report doesn't indicate any recent waning in the effectiveness of that combination therapy. Still, indications of antibiotic resistance among any gonorrhea treatments is considered troubling, the study authors said.

"It is essential to continue monitoring antimicrobial susceptibility and track patterns of resistance among the antibiotics currently used to treat gonorrhea," said study lead author Dr. Robert Kirkcaldy, an epidemiologist in the CDC's division of STD prevention in Atlanta. "Recent increases in cefixime resistance show our work is far from over."

The study findings are published as a research letter in the November 3 issue of the Journal of the American Medical Association.

The CDC noted that gonorrhea is spread during unprotected vaginal, anal, or oral sex. The sexually transmitted infection is particularly common among youth and young adults between the ages of 15 and 24. Many people have no symptoms when infected. When symptoms do occur, they may include a painful or burning sensation when urinating; painful, swollen testicles, and discolored discharge from the penis among men. In women, symptoms may include increased vaginal discharge and vaginal bleeding between periods. Rectal infections may spark soreness, itching, bleeding, discharge, and painful bowel movements, the CDC said.

If gonorrhea goes untreated, "serious health complications" can result, Kirkcaldy said. Those can include chronic pelvic pain, infertility, and life-threatening ectopic pregnancy. In rare cases, gonorrhea can spread to the blood or joints, causing a potentially life-threatening infection, the CDC warned. But when the illness is identified, antibiotics can provide an effective cure.

The new CDC study looked at treatment outcomes among male gonorrhea patients who had been treated at public clinics across the United States between 2006 and 2014. More than 51,000 samples were gathered across 34 cities. About one-third were collected in the western United States and one-third collected in the South. A little more than a quarter of the samples were drawn from men who either identified as gay or bisexual, the study said.

The investigators found that the CDC's 2012 shift away from recommending cefixime and toward ceftriaxone-based combination therapy had a profound impact: while the combination therapy had been given to less than 9% of the patients in 2006, that figure shot up to nearly 97% by 2014. Alongside that shift, the team found that cefixime resistance went up from 0.1% in 2006 to 1.4% in 2011, and then back down to 0.4% in 2013. But by 2014, resistance trended upward to 0.8%, the research revealed.

What does this mean? "Trends of cefixime susceptibility have historically been a precursor to trends in ceftriaxone," said Kirkcaldy. "So it's important to continue monitoring cefixime to be able to anticipate what might happen with other drugs in the future."

Dr. Kirsten Bibbins-Domingo, co-vice chair of the U.S. Preventive Services Task Force, emphasized the importance of routine screening. "The task force recommends screening for gonorrhea in sexually active women age 24 years or younger, and in older women who are at increased risk for infection," she said. The task force doesn't advocate for or against screening for men, saying more research is needed to prove its effectiveness. However, Kirkcaldy said that the "CDC recommends an annual gonorrhea screening for high-risk sexually active women and for sexually active gay, bisexual, and other men who have sex with men."

Source: HealthDay, November 4, 2015.

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