On Monday, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) announced the results of a promising new treatment for gonorrhea. In a clinical trial researchers combined existing antibiotics into two new drug regimens—injectable gentamicin in combination with oral azithromycin and oral gemifloxacin in combination with oral azithromycin. Both were able to successfully treat gonorrhea infections.
Once thought of as an eminently treatable infection, public health experts have been sounding alarm bells over the past few years as the bacterium that causes gonorrhea has become resistant to more and more of our existing drugs. As I explained in a piece for Rewire last year, as early as the 1940s, gonorrhea was resistant to sulfanilamides, and by the 1980s, penicillins and tetracyclines no longer worked. Later, in 2007, the CDC stopped recommending the use of fluoroquinolones (the class of drugs that includes Cipro). Today, the only class of antibiotics that remains effective is cephalosporins, but the bacterium’s susceptibility to these drugs is rapidly declining.
The findings from the new trial provide hope that existing drugs in new combinations will work. In fact, the trial found that the injectable gentamicin/oral azithromycin combination cured 100 percent of genital gonorrhea infections, the oral gemifloxacin/oral azithromycin cured 99.5 percent of genital cases, and both combinations cured 100 percent of infections of the throat and rectum. Researchers noted, however, that many patients in the trial complained of side effects, especially gastrointestinal issues.
While promising, the new trial does not change the CDC’s current treatment guidelines. CDC still recommends injectable ceftriaxone, in combination with either oral azithromycin or oral doxycycline. However, the studied combinations may be used in cases of severe allergy to the other drugs and will be considered as the CDC continues to evaluate and update its treatment guidelines.
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Advocates agree that this is an important interim step, but caution that combinations of existing drugs may not be the long-term solution we need. Dr. Gail Bolan, director of the CDC’s Division of STD Prevention, said in a statement, “These trial results are an exciting step in the right direction in the fight against drug-resistant gonorrhea. But patients need more oral options with fewer side effects. It is imperative that researchers and pharmaceutical companies prioritize research to continue to identify new, effective, better-tolerated drugs and drug combinations.”
William Smith, president of the National Coalition of STD Directors, agreed, explaining in a statement, “[W]e must remember these are existing antibiotics and gonorrhea has shown a remarkable ability to develop resistance quickly to all of our existing families of antibiotics. So while these treatments may buy us some additional time, we need investments in the creation of new antibiotics immediately.”
Smith and others also point out that preventing a widespread outbreak of antibiotic-resistant gonorrhea will take more than new treatment options. As Rewire has reported in the past, the system with which we screen, test, and treat sexually transmitted infections (STIs) is underfunded, outdated, and stretched beyond its limits.
There are approximately 800,000 cases of gonorrhea in the United States each year. Many people do not have any symptoms. Others may feel itching, burning, discharge, or pain during urination. If left untreated, gonorrhea can cause pelvic inflammatory disease and lead to infertility in both men and women. It is important that sexually active individuals get screened for this and other STIs. In addition, condoms are highly effective in preventing gonorrhea when used consistently and correctly.