Gonorrhea may be in the early stages of resisting antibiotics, with the percentage of bacteria fighting against the drug azithromycin having increased by more than 400% between 2013 and 2014 in the US. This according to a study that looked at a total of 5,093 isolates collected in 2014. Researchers found:

• 25.3% of the isolates were resistant to tetracycline; 19.2% to ciprofloxacin, and 16.2% to penicillin.

• Reduced azithromycin susceptibility increased from 0.6% in 2013 to 2.5% in 2014.

• The increase occurred in all geographic regions across the US, but was greatest in the Midwest, and among all categories of sex partners.

• The prevalence of cefixime resistance increased from 0.1% in 2006 to 1.4% in both 2010 and 2011, decreased to 0.4% in 2013, and increased to 0.8% in 2014.

• The percentage of isolates resistant to tetracycline, ciprofloxacin, penicillin, or all 3 antimicrobials, was greater in isolates from men who have sex with men than from men who have sex with women.

Citation: Kirkcaldy RD, Harvey A, Papp JR, et al. Neisseria gonorrhoeae antimicrobial susceptibility Surveillance—The Gonococcal Isolate Surveillance Project, 27 sites, United States, 2014. MMWR Surveill Summ. 2016;65:1-19. doi:10.15585/mmwr.ss6507a1.

Commentary: Gonorrhea (GC) is the second most commonly reported notifiable disease in the US, with chlamydia being the first. There are over a quarter of a million GC infections in the US annually. Emerging resistance is a concern with GC. Since 1989, penicillin has not been recommended for gonorrhea treatment because of high prevalence of resistance. Beginning in the early 2000’s, resistance to fluoroquinolones began to emerge. The increase was rapid, with almost no resistance in 2000, 7% resistance in 2004, and almost 15% resistance in 2007. In 2007, the CDC recommended that fluoroquinolones no longer be used to treat GC. The rate of resistance to azithromycin and to cefixime or ceftriaxone has remained low but has increased over the past decade. The current CDC recommendation for treatment of GC is based on combination therapy having a synergistic effect on elimination of GC, which is believed to decrease the probability of the emergence of resistance to azithromycin and cephalosporins. The current recommendation is that GC infections should be treated with ceftriaxone 250 mg as a single intramuscular dose along with azithromycin 1 g orally. —Neil Skolnik, MD