National Coalition of STD Directors (NCSD)'s Personal Blog
Gonorrhea Treatment Failure Reported in the United Kingdom
|National Coalition of STD Directors (NCSD) on June 27, 2016 at 02:46:10 PM|
Highlights Need for Extra-genital Screening and Reduction in Gonorrhea Morbidity in the U.S.
Washington, D.C. – A gonorrhea treatment failure in a heterosexual man in the United Kingdom was reported in the June 23rd edition of The New England Journal of Medicine. This patient presented with symptoms of an STD and tests of urine specimens and a throat swab came back positive for gonorrhea. After receiving dual treatment, his test of cure 15 days later showed that his urine specimen was negative but his throat swab remained positive. It was not until nearly four months after the infection was detected and after additional higher doses of the dual treatment that the infection was cleared.
No treatment failures have been reported in the United States, but this is the first reported treatment failure of a patient treated with dual therapy reported in Europe. While this patient was eventually effectively treated, this case is considered a treatment failure because the post-treatment isolate was resistant to ceftriaxone and azithromycin (the recommended drugs to treat gonorrhea both in the United Kingdom and the United States), all specimens contained resistance determinants and identical sequence types, and reinfection was deemed to be unlikely.
“This treatment failure is a wakeup call for the United States: gonorrhea will develop resistance to the current last line of drugs to treat it here in the United States,” stated William Smith, Executive Director of the National Coalition of STD Directors. “To prepare for this reality, we need additional drugs to fight this infection. But it is also vital that we work to reduce gonorrhea burden, ensure correct treatment, and have robust surveillance to monitor gonorrhea here in the United States. And these functions are only completed by robust funding of the STD public health system which remains anemic and on the chopping block year after year,” continued Smith.
Last week, NCSD sent a letter to Congress decrying a proposed cut to the Division of STD Prevention (DSTDP) at the CDC that is contained in the current Senate fiscal year (FY) 2017 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill. This proposed cut for FY17 funding comes on the heels of another proposed devastating cut the prior year of 20 percent to DSTDP from the Senate, against which NCSD also successfully lead the fight.
This treatment failure also highlights the challenges of treating gonorrhea of the throat and underscores the need for screening patients at all the sites where they engage in sexual activity. As stated in the report: “The treatment failure reflected difficulties in treating pharyngeal gonorrhea as compared to urogenital gonorrhea. Pharyngeal gonorrhea is rare in heterosexual men. However, this patient reported no homosexual exposure; this highlights the need to test all potential sites of infection.”
This patient was initially treated with 500 mg of ceftriaxone delivered intramuscularly (which is double the CDC recommended treatment of ceftriaxone for gonorrhea in the United States) plus 1 g of oral azithromycin. His second treatment, which eventually did clear the infection, was of 1 g of ceftriaxone delivered intramuscularly plus 2 g of oral azithromycin. For both urogenital and pharyngeal gonorrhea infections, the CDC recommends 250 mg of ceftriaxone delivered intramuscularly and 1 g of azithromycin delivered orally.
“This patient needed four times the CDC recommended amount of ceftriaxone and double the amount of azithromycin to clear this pharyngeal infection,” stated Dr. Peter Leone, NCSD Consultant and Former Chair, NCSD Board of Directors. “This underscores the seriousness of gonorrhea resistance across the globe and here in the United States, and shows us that cases can be missed if testing at all potential sites of infection does not occur,” continued Leone.