CDC Reports the Emergence of Antibiotic-Resistant Gonorrhea

The development of antibiotic resistance in Neisseria gonorrhoeae is a growing public health concern, in particular because the United States gonorrhea control strategy relies on effective antibiotic therapy. Since antibiotics were first used for treatment of gonorrhea, N. gonorrhoeae has progressively developed resistance to the antibiotic drugs prescribed to treat it: sulfonilamides, penicillin, tetracycline, and ciprofloxacin. Currently, CDC STD treatment guidelines recommend dual therapy with the injectable cephalosporin ceftriaxone and either azithromycin or doxycycline to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. Dual therapy is recommended to address the potential emergence of gonococcal cephalosporin resistance. Given the ability of N. gonorrhoeae to develop antibiotic resistance, it is critical to continuously monitor gonococcal antibiotic resistance and encourage research and development of new treatment regimens for gonorrhea.


Surveillance for antimicrobial resistance in N. gonorrhoeae in the United States is conducted through the Gonococcal Isolate Surveillance Project (GISP). Approximately 25-30 sites and 4-5 regional laboratories across the United States participate in GISP. Data from this project have been reported and have directly contributed to CDC's STD Treatment Guidelines in 1989, 1993, 1998, 2002, 2006, and 2010.


Susceptibility testing for the cephalosporin antibiotics is being conducted in GISP on ceftriaxone, cefixime, and cefpodoxime. CDC has observed recent worrisome trends in decreasing cephalosporin susceptibility, especially to oral cephalosporins such as cefixime. So far, none of the N. gonorrhoeae isolates tested in GISP have exhibited resistance, and CDC has not received any reports of clinical treatment failures to any cephalosporin in the United States.


In 2010, 27.2% of isolates collected in GISP were resistant to penicillin, tetracycline, ciprofloxacin, or a combination of these antimicrobials.


See the CDC Report