A growing strain of gonorrhea that’s resistant to all available drugs should spur a change in how the disease is treated in the U.S., where the type hasn’t yet been seen, according to health officials.
Doctors now need to use more potent injections instead of cefixime, the pill that was the standard of care, according to the U.S. Centers for Disease Control. Resistant gonorrhea was reported in 17 European countries in 2010, an increase from seven a year earlier, according to a survey released in June.
Treatment options have shrunk as every medicine starting with penicillin loses effectiveness against gonorrhea, the second-most commonly reported infectious disease in the U.S. with about 700,000 new cases a year. The cefixime pill and the more-potent ceftriaxone injection belong to the only class of effective drugs left to use, the agency said in a report today.
“Action is urgently needed to prevent untreatable gonorrhea from becoming a reality,” said Gail Bolan, director of the Atlanta-based CDC’s division of sexually-transmitted disease prevention, in a telephone interview.
The CDC guidelines were last updated in 2007, when the bacteria demonstrated resistance to the fluoroquinolone class of medicines, and the agency recommended discontinuing their use. Cefixime and ceftriaxone are members of a family of drugs known as cephalosporins.
The increases in strains with less responsiveness to the cephalosporins were most prominent in samples from the western U.S. and from gay and bisexual men across the country. The same pattern existed when resistance to fluoroquinolones increased.
“Gonorrhea is very good at picking up antibiotic resistance,” said Carlos del Rio, a professor of medicine at Emory University in Atlanta and a part of the CDC’s gonorrhea surveillance program, by telephone. “In a way, it’s the canary in the coal mine for antibiotic resistance in the STD setting.”
While gonorrhea infections often are symptomless, they can lead to infertility and other serious conditions if untreated. Screening is necessary because many infections are “silent,” with few or no symptoms, Bolan said. Less than half of new cases are diagnosed each year.
Companies have been reluctant to invest in developing new antibiotics because they are used sparingly, and often held in reserve to prevent resistance, del Rio said. There’s little incentive to develop new drugs because there isn’t as much profit in them, he said.
“The industry doesn’t do work based on public health,” del Rio said. “They work based on what’s going to benefit their stockholders.”
In June, the U.S. Senate reauthorized the Prescription Drug User Fee Act in June, adding a section called “Generating Antibiotic Incentives Now,” to encourage drugmakers to develop new antibiotics for life-threatening infections. Under the new language, qualified drugs would receive an additional five years of market exclusivity and a faster review.
The legislation “isn’t enough to fix the problem,” said Robert Guidos, vice president for public policy at the Infectious Diseases Society of America, based in Arlington, Virginia. “It’s valuable, and it’s obviously sparked a lot of attention in industry. But it isn’t enough.”
Other options that may help may be research and development tax credit, or strengthening partnerships between public health officials and private industry may also help, he said.