The Growing Threat of Multidrug-Resistant Gonorrhea

This session of Grand Rounds explored the development of antibiotic resistance in Neisseria gonorrhoeae as a growing public health concern because the United States gonorrhea control strategy relies on effective antibiotic therapy. Since antibiotics were first used for treatment of gonorrhea, N. gonorrhoeae has progressively developed resistance to the antibiotic drugs prescribed to treat it: sulfonilamides, penicillin, tetracycline, and ciprofloxacin. Currently, CDC STD treatment guidelines recommend dual therapy with a cephalosporin antibiotic (ceftriaxone is preferred) and either azithromycin or doxycycline to treat all uncomplicated gonococcal infections among adults and adolescents in the United States.

Given the ability of N. gonorrhoeae to develop antibiotic resistance, it is critical to continuously monitor gonococcal antibiotic resistance and encourage research and development of new treatment regimens for gonorrhea.

A major challenge to monitoring emerging antimicrobial resistance of N. gonorrhoeae is the substantial decline in capability of laboratories to perform essential gonorrhea culture techniques required for antibiotic susceptibility testing. This decline results from an increased use of newer non-culture-based laboratory technology, such as a diagnostic test called the Nucleic Acid Amplification Test (NAAT). Currently, there is no reliable technology that allows for antibiotic susceptibility testing from non-culture specimens. Increased laboratory culture capacity is needed.

Presented By

Edward Hook III, MD
Professor of Medicine and Epidemiology
University of Alabama, Birmingham
Presentation: Neisseria Gonorrhoeae Infections and Antimicrobial Treatment: Public Health Context and Challenges

William Shafer, PhD
Professor of Microbiology and Immunology
Emory University
Presentation: Molecular Basis of Resistance & Importance of the Laboratory in Detection of Resistance

Carolyn Deal, PhD
Chief, Sexually Transmitted Diseases Branch
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Presentation: Tools to Combat Multidrug Resistance

Robert D. Kirkcaldy, MD, MPH
Medical Officer
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Presentation: What public health can do now and in the Future

Facilitated By

Tanja Popovic, MD, PhD, Scientific Director, Public Health Grand Rounds
John Iskander, MD, MPH, Deputy Scientific Director, Public Health Grand Rounds
Susan Laird, MSN, RN, Communications Manager, Public Health Grand Rounds

Additional Resources

• Gonorrhea Fact Sheet
• Antibiotic Resistance Gonorrhea website
• GISP website
• 2011 MMWR on Cephalosporin susceptibility in GISP
• Fact sheet to accompany the July 2011 MMWR
• The New England Journal of Medicine Perspectives February 9, 2012 “The Emerging Threat of Untreatable Gonococcal Infection.”