In June, I wrote a piece titled No Clapping Matter, which discussed the impending threat of antibiotic-resistant gonorrhea and the need to take action soon. Today, the Centers for Disease Control and Prevention (CDC) announced new treatment guidelines for gonorrhea and released a plan to address antibiotic-resistant strains of the disease.
Gonorrhea is one of the most common Sexually Transmitted Infections (STIs) with over 700,000 cases in the United States each year. The infection may cause itching, burning, discharge, or pain during urination, but often has no symptoms. If left untreated, however, it can cause pelvic inflammatory disease and lead to infertility in both men and women.
While gonorrhea is treatable with antibiotics, over the years Neisseria gonorrhoeae has steadily developed resistance to an entire classes of antibiotics. As early as the forties it was resistant to sulfanilamides; by the eighties, penicillins and tetracyclines no longer worked; in 2007 the CDC stopped recommending the use of fluoroquinolones (the class of drugs that includes Cipro, which we may all remember as the thing to stockpile in case of an anthrax attack). Today, the only class of antibiotics that remains effective are cephalosporins, but its susceptibility to these drugs is declining rapidly in the United States and other countries have already seen cephalosporin-resistant cases.
Earlier this year, the CDC suggested that it was time to change the way we screen for and treat gonorrhea in this country in order to respond to this wily germ, and in June the World Health Organization (WHO) released a global action plan for stemming the spread of drug-resistant gonorrhea. Today, the CDC took additional steps to help public health experts in the United States address this emerging threat.
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First, the CDC changed its treatment guidelines. The previous guidelines recommended oral antibiotics as the first line of defense against the infection. The new guidelines instead recommend that infection be treated with injectable ceftriaxone in combination with one of two oral antibiotics—doxycycline or azithromycin. In addition, the CDC published the Cephalosporin-Resistant Gonorrhea Public Health Response Plan, which makes a number of recommendations for scaling up the in the activities of health departments in order to monitor resistance and ensure effective treatment of gonorrhea infections.
Experts in the field believe that these are good steps to take but warn that they may be difficult given the current funding situation and, moreover, that they may not be enough. William Smith, the executive director of the National Coalition of STD Directors (NCSD) explains:
The response plan includes a number of recommendations that are imperative to protect the public’s health, but NCSD’s member health departments throughout the country have seen drastic budget cuts, furloughs and layoff of staff, and have constricted program activities over the past several years to the point where most are as bare bones as one can imagine. In the face of this real and emerging threat, federal, state, and local governments must reinvest in health department STD programs without delay.
Similarly, Smith believes that the new treatment guidelines are a step in the right direction but that without an investment in new antibiotics, a long-term solution will not be found. He explains:
…the rising resistance of gonorrhea to our last line of defense against it must be a clarion call to policymakers and private industry alike to invest in the research and development pipeline for new antibiotics and more sophisticated diagnostics…and quickly. We desperately need additional options to meet the challenges of this infection.
As I said is my last article on this topic, the thing that keeps getting to me is the sense that few people are alarmed about the emergence of antibiotic-resistant gonorrhea or panicked by the lack of new drugs in the pipeline to treat this and other common bacterial infections which are also becoming resistant to existing drugs. We have become too used to brushing off everything from ear-infections to strep throat to STIs as treatable nuisances. Hopefully, these new resources from the CDC will remind people to take this emerging problem seriously and invest in the infrastructure and research we need before it’s too late.