Preventing Antibiotic-Resistant Gonorrhea by Changing Treatment Guidelines and Educating Health Care Providers

Prevention Case Study 3

People who are sexually active can get gonorrhea, a common sexually transmitted disease (STD). It usually causes infection in the genitals, rectum, or throat, but it also can spread to the bloodstream, heart, and nervous system. A pregnant person with gonorrhea can give the infection to their baby during delivery. This can cause serious health problems, including blindness, for the baby.

During 2019, a total of 616,392  cases of gonorrhea in the United States were reported to CDC. This is a rate of 188.4 gonorrhea cases per 100,000 persons. Moreover, the rate of gonorrhea cases has increased  92% since 2009.1 Without treatment, gonorrhea can cause serious and permanent health problems, including infertility in women.  Gonorrhea can be treated with medicine, but the bacteria can develop resistance to antibiotics over time. The term antibiotic resistance means that medicines that have been used to treat an infection may no longer work.

What steps has CDC taken to combat antibiotic-resistant gonorrhea and to save heath care costs?

CDC monitors Neisseria gonorrhoeae, the bacterium that causes gonorrhea, and its susceptibility to antibiotics through the Gonococcal Isolate Surveillance Project. As CDC learns that gonorrhea has developed resistance to a previously effective antibiotic regimen, it updates its recommendations for health care providers. Since 2000, CDC has updated its gonorrhea treatment recommendations multiple times as a result of increasing resistance, with the last update in 2021 (for more information, see STI Treatment Guidelines, 2021).

Antibiotic resistance can make treating gonorrhea and preventing its spread much more difficult, resulting in an even greater increase in gonorrhea cases in the United States. By preventing antibiotic resistance, CDC can prevent gonorrhea cases, which limits additional medical complications and saves health care costs. For example, emerging cephalosporin resistance could lead to more than 1 million additional gonococcal infections and 600 additional gonorrhea-attributable HIV (human immunodeficiency virus) infections, at a cost of approximately $400 million over 10 years.2

Educating Health Care Providers and Changing Treatment Practices

To prevent antibiotic-resistant gonorrhea, health care providers should update their treatment practices to be consistent with CDC’s current STD Treatment Guidelines. CDC funds the National Network of STD Clinical Prevention Training Centers (NNPTC), which is a group of clinical training centers created in partnership with health departments and universities. NNPTC provides health professionals with state-of-the-art educational opportunities, including telehealth and online curricula focused on STD treatment and prevention. NNPTC seeks to improve STD clinical care training at multiple levels — individual doctors, other health care professionals who treat persons who have or are at risk for STDs, and clinical organizations and health care systems. Each year, NNPTC trains more than 25,000 health care professionals.

Previous evaluations of health care professionals’ treatment practices after CDC publishes new STD treatment guidelines indicate that providers are aware of the updated guidelines and that they change their practices in response.3,4,5,6,7 For example, the 2015 STD Treatment Guidelines recommended ceftriaxone 250 mg plus azithromycin 1 g as the only recommended treatment regimen for uncomplicated gonorrhea. In 2016, a review of U.S. surveillance data demonstrated that 81% of reported gonorrhea cases were treated with this recommended regimen. The adherence to the recommended regimen was higher among STD clinics (91%) and family planning or reproductive health clinics (94%). In 2021, the update to the STD Treatment Guidelines recommended a higher ceftriaxone dose of 500 mg (for a person weighing <150 kg) as monotherapy as the only recommended regimen for uncomplicated gonorrhea. Data are not yet available for the adherence to the 2021 guidelines, which were released in July 2021.

  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2019. Atlanta: U.S. Department of Health and Human Services; 2021
  2. Chesson HW, Kirkcaldy RD, Gift TL, Owusu-Edusei K Jr, Weinstock HS. An Illustration of the Potential Health and Economic Benefits of Combating Antibiotic-Resistant Gonorrhea. Sex Transm Dis. 2018;45(4):250-253. doi:10.1097/OLQ.0000000000000725
  3. Weston EJ, Workowski K, Torrone E, Weinstock H, Stenger MR. Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea — STD Surveillance Network, United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:473–476. DOI: icon.
  4. Kerani RP, Stenger MR, Weinstock H, et al. Gonorrhea treatment practices in the STD Surveillance Network, 2010-2012. Sex Transm Dis 2015;42:6–12.
  5. Dowell D, Tian LH, Stover JA, et al. Changes in fluoroquinolone use for gonorrhea following publication of revised treatment guidelines. Am J Public Health 2012;102:148–55.
  6. Lechtenberg RJ, Samuel MC, Bernstein KT, Lahiff M, Olson N, Bauer HM. Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011. Sex Transm Dis 2014;41:338–44.
  7. Swails J, Smock L, Hsu K. Provider characteristics associated with guideline-nonadherent gonorrhea treatment, Massachusetts, 2010. Sex Transm Dis 2014;41:133–6
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