September 22, 2000
Contact: CDC, National Center for HIV, STD & TB Prevention
(404) 639–8895

Facts About Drug-Resistant Gonorrhea

• As drug-resistant strains of gonorrhea continue to emerge, successful treatment of this sexually transmitted disease (STD) is becoming more difficult. In the 1980s, gonorrhea became resistant to penicillin and tetracycline, rendering these drugs ineffective treatment for gonorrhea. As a result, since 1989, the Centers for Disease Control and Prevention (CDC) has recommended fluoroquinolone antibiotics – such as ciprofloxacin – as treatment for gonorrhea. According to a report in the September 22 issue of the MMWR, increased levels of fluoroquinolone-resistant gonorrhea now are being reported in Hawaii, increasing from 1.4% of strains tested in 1997 to 9.5% in 1999.
  
  
• Consequently, CDC recommends that health care providers ask patients with gonorrhea if they or their sex partners could have acquired the disease in Hawaii, other Pacific Islands, or Asia, where fluoroquinolone-resistant gonorrhea is common. If so, patients should be treated with cefixime or ceftriaxone, which are other drugs that are currently recommended for treating gonorrhea, and to which no resistance has been reported.
  
  
• In addition, CDC is seeing the first indication that gonorrhea may be becoming resistant to yet another drug. The first reported cluster of patients – 12 people – with gonorrhea with decreased susceptibility to azithromycin, another commonly used antibiotic, was found in Kansas City, Mo., in 1999.
  
  
• The resistance in Hawaii and Missouri were discovered through the Gonococcal Isolate Surveillance Project (GISP), a CDC-sponsored surveillance system, which monitors drug resistance of gonorrhea. Throughout the United States, 26 sexually transmitted disease clinics participate in GISP by collecting gonorrhea cultures and submitting them to one of five regional GISP laboratories for antimicrobial susceptibility testing.
  
  
• In view of these findings from GISP, if an antibiotic fails to successfully treat a patient infected with gonorrhea, health care providers are urged to submit patient specimens to their local laboratories for drug-resistance testing.
  
  
• If not treated successfully, gonorrhea can cause pelvic inflammatory disease (PID), infertility, ectopic pregnancy, and chronic pelvic pain. Previous studies also have shown that gonorrhea can facilitate HIV transmission. The estimated direct medical cost of treating gonorrhea in the United States is $56 million each year. Gonorrhea is the second most common disease reported to CDC, with more than 360,000 cases reported in 1999.
  
  
• On September 20, 2000, CDC Director Jeffrey P. Koplan, MD, MPH, testified on antimicrobial resistance before the Senate Subcommittee on Labor, Health and Human Services and Education. If you would like a copy of his testimony, contact CDC, Division of Media Relations at (404) 639–3286.

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