CDC Changes Recommendations for Gonorrhea Treatment Due to D

CDC Changes Recommendations for Gonorrhea Treatment Due to Drug Resistance

ATLANTA, GA -- April 13, 2007



The CDC no longer recommends antibiotics known as fluoroquinolones
(ciprofloxacin, ofloxacin, and levofloxacin) as a treatment for
gonorrhea in the United States. This limits the options available to
treat gonorrhea, one of the most common sexually transmitted diseases
in the United States.



The recommendation was prompted by new data released today in CDC's
Morbidity and Mortality Weekly Report (MMWR) showing that
fluoroquinolone-resistant gonorrhea is now widespread in the United
States among heterosexuals and men who have sex with men (MSM). The
data showed the proportion of drug-resistant cases among heterosexuals
rising above the recognized threshold of 5% for changing treatment
recommendations. CDC had recommended fluoroquinolones no longer be used
to treat gonorrhea in MSM when this threshold was crossed in earlier
years.



The new data, from CDC's Gonococcal Isolate Surveillance Project (GISP)
in 26 U.S. cities, showed that among heterosexual men, the proportion
of gonorrhea cases that were fluoroquinolone-resistant Neisseria
gonorrhoeae (QRNG) reached 6.7% in the first half of 2006, an 11-fold
increase from 0.6% in 2001.



Recommended options for treating gonorrhea are now limited to a single
class of antibiotics known as cephalosporins. Public health officials
believe the lack of treatment options underscores the need for
accelerated research into new drugs, as well as increased efforts to
monitor for emerging drug resistance, especially to cephalosporins.



"There is also an urgent need for new, effective medicines to treat
gonorrhea. We are running out of options to treat this serious
disease," said Kevin Fenton, MD, PhD, Director of CDC's National Center
for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. "Increased
vigilance in monitoring for resistance to all available drugs is
essential."



While significant resistance to cephalosporins has not been observed to
date, CDC is working with state and local health departments to monitor
emerging cephalosporin resistance. CDC is urging health departments to
maintain or develop capacity to perform cultures for Neisseria
gonorrhoeae and to assess any gonorrhea treatment failures for possible
resistance. In addition, CDC is working with the World Health
Organization to strengthen international efforts to monitor for the
emergence of cephalosporin resistance and with government and industry
partners to identify and evaluate promising new drug regimens. These
additional measures are critical for the control of gonorrhea.



Oral fluoroquinolones were recommended as first-line treatments for
gonorrhea in 1993. But drug resistant cases have increased steadily in
recent years, rising first in the western United States and then among
MSM nationwide. In 2002, CDC recommended that fluoroquinolones not be
used to treat gonorrhea infections acquired in California and Hawaii,
and in 2004 that the drugs no longer be used to treat MSM with these
infections.



The new CDC analysis shows an increase in the past five years in the
overall proportion of gonorrhea cases that are
fluoroquinolone-resistant – from less than 1% in 2001 to 13.3 percent
in the first half of 2006. The analysis also indicated that
fluoroquinolone resistance is widespread geographically. Resistant
cases were seen across the United States in the first half of 2006 (in
25 of the 26 cities in the analysis), and sharp increases occurred from
2004 to 2006 in several cities, including Philadelphia (from 1.2% to
26.6% of gonorrhea cases) and Miami (from 2.1% to 15.3%). In addition,
the analysis showed QRNG continued to rise among MSM; 38% of MSM
gonorrhea cases were QRNG in the first half of 2006, compared to 1.6%
in 2001.



Within the class of cephalosporins, CDC now recommends ceftriaxone,
available as an injection, the preferred treatment for all types of
gonorrhea infection (genital, anal, and throat). For genital and anal
gonorrhea, there are some alternative oral cephalosporin treatments
that physicians can consider, but there are currently no recommended
alternatives for pharyngeal infection.



"New treatment recommendations are critical if we are to continue to
see progress in controlling gonorrhea," said John Douglas, MD, director
of the Division of STD Prevention. "We cannot afford to lose ground
against a disease that continues to affect roughly 700,000 Americans
each year."



Gonorrhea is the second most commonly reported infectious disease in
the United States after chlamydia. In 2005, 339,593 cases were reported
nationwide, although experts believe the actual number of cases may be
twice that. Following a substantial decline in national gonorrhea rates
from 1975 to 1997, overall rates appear to have leveled off in recent
years.



States participating in GISP include Alabama, Arizona, California,
Colorado, Florida, Georgia, Hawaii, Illinois, Louisiana, Maryland,
Michigan, Minnesota, Nevada, New Mexico, North Carolina Ohio, Oklahoma,
Oregon, Pennsylvania, Texas, and Washington.



Additional information on available gonorrhea treatments can be found at: