1 in 5 patients with gonorrhea gets wrong treatment
Gonorrhea is the second most common notifiable disease in the United States behind chlamydia, with over 468,000 cases reported in 2016. But unlike chlamydia, which is still reliably treated with antibiotics, gonorrhea has become increasingly drug resistant — potentially even untreatable in some cases — and new research shows that nearly one in five patients in the U.S. may not receive the recommended front-line treatment.
Experts have described Neisseria gonorrhoeae, the bacterium that causes gonorrhea, as “a very smart bug” with an “endless capacity to evolve resistance.” To keep pace, the CDC has revised its gonorrhea treatment guidelines twice in the last 6 years and now recommends a dual therapy of intramuscular ceftriaxone (250 mg) and oral azithromycin (1 g) for the best patient outcomes and to help prevent antimicrobial resistance.
To monitor adherence to the guidelines, Emily J. Weston, MPH, an epidemiologist in the CDC’s Division of STD Prevention, and colleagues analyzed data from 2016 at seven surveillance sites in the U.S. and estimated that 81% of patients with gonorrhea received the recommended first-line treatment, which they characterized as a “high” level of compliance with the recommendations.
According to Weston and colleagues, most patients treated with other regimens received only one antimicrobial, including 3% of all patients who received azithromycin monotherapy, which is not recommended because of concerns about emerging resistance and case reports of treatment failures, Weston and colleagues said. The most frequently prescribed inappropriate regimen for patients with gonorrhea in 2016 was ceftriaxone 250 mg alone, prescribed almost 6% of the time.