In the era of HIV and AIDS, perhaps old-fashioned sexually-transmitted diseases (STD) like gonorrhea don't seem like much of a threat anymore. But in the case of gonorrhea, it's a bigger threat than you might think.
That's because doctors have been treating it for decades with antibiotics, which have proved effective. But that appears to be changing. Over the years a strain of the disease has developed a strong antimicrobial resistance to the point that public health officials are alarmed.
Drug after drug that was once used to treat this most common of STDs no longer works. The National Coalition of STD Directors (NCSD), a Washington-based group that represents the interests of state and local STD program directors, warns that medical science is down to one effective drug to treat gonorrhea. Should the disease develop a resistance to that, the group warns that we could be looking at a devastating epidemic of gonorrhea.
Another major concern with gonorrhea is that it's symptoms are often overlooked. Left untreated, it can lead to long-term health consequences, including chronic pelvic pain, ectopic pregnancy, and infertility. Gonorrhea can also increase the risk of contracting and transmitting HIV, according to the Centers for Disease Control and Prevention (CDC).
Dr. Bob Kirkcaldy, Medical Officer in the Division of STD Prevention at the CDC, says there were more than 300,000 cases of gonorrhea reported to CDC in 2010. The CDC, however, estimates that more than twice that number – 700,000 – are infected each year.
“Cephalosporins are currently recommended to treat gonorrhea in the United States,” Kirkcaldy said. “For the past few years, providers have used combination therapy with either cefixime, an oral cephalosporin, or ceftriaxone, an injectable cephalosporin, plus a second antibiotic, to treat this common STD.”
Kirkcaldy says recent data suggest cefixime has become less effective as a gonorrhea treatment and CDC no longer recommends it. Instead, CDC now recommends using ceftriaxone along with a second antibiotic to treat the STD.
Old drugs no longer work
For years, gonorrhea was treated with a single oral dose of antibiotics. However, a strain of the disease has progressively acquired a resistance to the drugs used against it. Sulfonamides became ineffective in the 1940s, penicillins and tetracyclines in the 1970s and 80s and floroquinolenes by 2007.
For patients with uncomplicated genital, rectal, and pharyngeal gonorrhea, CDC now recommends combination therapy with ceftriaxone as a single intramuscular dose, plus either azithromycin orally in a single dose or doxycycline orally twice daily for seven days.
From the perspective of the NCSD, gonorrhea can no longer be ignored, and at a time of tightened government purse strings, there is a push for new spending.
"Experts agree that it's not a matter of if gonorrhea resistance will hit, it's a matter of when it will hit," said William Smith, Executive Director of NCSD. "If we aren't prepared when it happens we will have a serious public health crisis our hands, with only a lack of attention and investment to blame."
NCSD is urging Congress to spend $53.48 million to prepare for the time when gonorrhea no longer responds to current drugs. The money, the group says, should be divided up among state and local health departments tasked with responding, monitoring, and containing STD outbreaks in the U.S.