Preparing for an Era of Untreatable Gonorrhea #MMPMID24685549
Barbee LA
Curr Opin Infect Dis 2014[Jun]; 27 (3): 282-7 PMID24685549show ga
Purpose of Review: The proportion of Neisseria gonorrhoeae isolates with reduced susceptibility to extended-spectrum cephalosporins (ESC) 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 increased in isolates with decreased susceptibility to ESCs, there have been reported treatment failure 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 which 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 plus 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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Curr+Opin+Infect+Dis 2014 ; 27 (3): 282-7
