Completely Incurable Gonorrhea May Be at Hand

Gonorrhea cases that are completely resistant to oral antibiotics have been detected in at least nine North American patients, which could mean the era of incurable gonorrhea could be close.

Researchers at Public Health Ontario (Toronto, Canada) conducted a retrospective cohort study of 291 culture-positive Neisseria gonorrhoeae infections at a single sexual health clinic in Toronto (Canada). The cohort comprised culture-positive individuals identified between May 1, 2010, and April 30, 2011, who were treated with the oral cephalosporine cefixime, the last remaining effective oral antibiotic used to treat the disease. The main outcome measures were cefixime treatment failure, defined as the repeat isolation of N. gonorrhoeae at the test-of-cure visit identical to the pretreatment isolate by molecular typing.

The results showed that of the 291 culture-positive individuals identified, 133 returned for test of cure, of which 13 were culture positive; nine patients were determined to have experienced treatment failure, involving urethral, pharyngeal, and rectal sites. The overall rate of clinical treatment failure among those who had a test of cure was 6.77%. All nine patients were subsequently cured with an injectable antibiotic known as ceftriaxone. The study was published online on January 9, 2013, of the Journal of the American Medical Association (JAMA).

“Our results aren't generalizable to the overall population because they all came from one clinic; but basically, the problem appears worse than we originally thought,” said lead author Vanessa Allen, MD, MPH. “I think without a doubt this will become a bigger problem. The next threat is when, not if, the same thing happens with ceftriaxone. And then what?”

Gonorrhea (colloquially known as the clap) is a common human sexually transmitted infection caused by the bacterium N. gonorrhoeae. The usual symptoms in men are burning sensation with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain. Although cephalosporins are the cornerstone of treatment of N. gonorrhoeae infections, cefixime is the only oral antimicrobial option. Increased minimum inhibitory concentrations (MICs) to cefixime have been identified worldwide and have been associated with reports of clinical failure.

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