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2014 ; 27
(3
): 282-7
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Preparing for an era of untreatable gonorrhea
#MMPMID24685549
Barbee LA
Curr Opin Infect Dis
2014[Jun]; 27
(3
): 282-7
PMID24685549
show ga
PURPOSE OF REVIEW: The proportion of Neisseria gonorrhoeae isolates with reduced
susceptibility to extended-spectrum cephalosporins (ESCs) has increased rapidly
since 2006. Clinicians, researchers, and public health officials need to be
prepared for the possibility of an era of untreatable gonorrhea. This review
focuses on the evidence for current gonorrhea treatment recommendations,
potential future treatment options, and other methods to control gonorrhea.
RECENT FINDINGS: In addition to an increase in isolates with decreased
susceptibility to ESCs, there have been reported treatment failures to both
cefixime and ceftriaxone. In response, some countries have increased the
recommended cephalosporin dose, and most now recommend dual therapy with an ESC
and azithromycin. The pharynx has been implicated as a site for acquiring
resistance through transformation with commensal Neisseria species or induced
resistance through subtherapeutic antimicrobial levels. Thus, appropriate
screening of the pharynx and treatment with a regimen that eradicates gonorrhea
from the pharynx is necessary. At present, several studies are evaluating various
novel treatment regimens in preparation for an era of untreatable gonorrhea.
SUMMARY: Screening for asymptomatic infections, maintaining culture capacity to
monitor antimicrobial resistance, treating with ceftriaxone and azithromycin, and
ensuring that all sexual partners are treated are among the best strategies to
control gonorrhea in the current clime.
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