Preventing Antibiotic-Resistant Gonorrhea by Changing Treatment Guidelines and Educating Health Care Providers
Prevention Case Study 3
Gonorrhea is a common sexually transmitted disease (STD) that infects both men and women. It usually causes infection in the genitals, rectum, or throat, but it also can spread to the bloodstream, heart, and nervous system. If a pregnant woman is infected, gonorrhea can cause blindness in the newborn child.
During 2016, a total of 468,514 cases of gonorrhea in the United States were reported to CDC. This is a rate of 146 gonorrhea cases per 100,000 persons. Moreover, the rate of gonorrhea cases has increased 48.6% since 2009. 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 guidelines six times, with the last update in 2015 (for more information, see Antibiotic-Resistant Gonorrhea).
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 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.
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 Centersexternal icon (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.
Evaluations of health care professionals’ treatment practices when CDC publishes new guidelines indicate that providers are aware of the updated guidelines and that they change their practices in response. For example, beginning in 2010, CDC recommended using single-dose injectable cephalosporin (along with an oral antibiotic) as the preferred frontline therapy for uncomplicated gonococcal infections. Six city and state health departments collaborating in an enhanced surveillance project completed an evaluation of 271,868 gonorrhea cases reported to them during 2010–2016. They estimated that the proportion of cases treated with the injectable cephalosporin (ceftriaxone) across all provider settings increased from 67% in 2010 to 87% in 2012; the proportion then increased further and remained constant at more than 90% during 2015 and 2016.