On Monday, the Centers for Disease Control and Prevention (CDC) released a new report about drug-resistant bacteria, which categorizes pathogens by threat-level: urgent, serious, or concerning. Not surprisingly, Neisseria gonorrhoeae, the bacteria that causes gonorrhea, was named an “urgent threat.” As RH Reality Check has been reporting for over a year, evidence suggests that if nothing is done, the United States will soon see cases of antibiotic-resistant gonorrhea.
The CDC estimates that there are more than 800,000 new cases of gonorrhea in the United States annually, making it one of the most common sexually transmitted infections (STIs). 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. Gonorrhea is treatable with antibiotics, but Neisseria gonorrhoeae has steadily developed resistance to entire classes of antibiotics. Between 1940 and 2007, it became resistant to sulfanilamides, penicillins, tetracyclines, and fluoroquinolones. Today, cephalosporins remain effective, but in the United States its susceptibility is declining, and other countries are seeing cephalosporin-resistant cases.
The CDC now recommends ceftriaxone plus either azithromycin or doxycycline as first-line treatment for gonorrhea. In 2011, there were 3,280 cases of gonorrhea that had reduced susceptibility to ceftriaxone and 2,460 that had reduced susceptibility to azithromycin. The CDC report notes that “cephalosporin resistance, especially ceftriaxone resistance, would greatly limit treatment options and could cripple gonorrhea control efforts.” It goes on to say:
If cephalosporin-resistant N. gonorrhoeae becomes widespread, the public health impact during a 10-year period is estimated to be 75,000 additional cases of pelvic inflammatory disease (a major cause of infertility), 15,000 cases of epididymitis, and 222 additional HIV infections, because HIV is transmitted more readily when someone is co-infected with gonorrhea. In addition, the estimated direct medical costs would total $235 million.
Public health advocates have been warning of this kind of outbreak for some time and have asked Congress to invest additional money into testing, tracking, and treatment. In April, advocates addressed Congress, asking for $54 million in emergency funding to improve the nation’s STD public health infrastructure. William Smith, president of the National Coalition of STD Directors (NCSD), one of the organizations behind the request, said in a statement Monday, “So while some would say that we cannot afford additional investments in gonorrhea prevention now, this report, again, makes one thing clear: we can invest $54 million dollars now to better prepare those on the front lines of drug-resistant gonorrhea, or we can pay hundreds of millions of dollars later when drug-resistant gonorrhea is widespread.”
Smith’s organization would like to see this money used to train private providers in proper diagnosis and treatment protocols, increase both lab and surveillance capabilities across the country, train additional disease intervention specialists (professionals who work with patients to identify partners and then work to contact and treat those partners), fund evidenced-based programs such as expedited partner therapy, which allows health-care providers to write prescriptions for patients’ partners without a visit, and create public education campaigns. NCSD is also calling on its industry partners to create new tests for gonorrhea—similar to ones that already exist for tuberculosis—that can determine resistance right away so providers know what drugs to use.
In addition to these efforts to improve testing and treatment for gonorrhea, it is also important that the heath industry and government work together to create new antibiotics. In releasing the report, which addresses a number of other drug-resistant bacteria as well, CDC Director Thomas Frieden warned of a post-antibiotic era in which nothing we have now works and nothing new has been invented. He said if the current trend continues, “the medicine cabinet may be empty for patients who need them in the coming months or years.”
This new report sounds the alarm and suggests four core actions for dealing with these threats: preventing infections, tracking resistance patterns, improving how antibiotics are prescribed and used (to prevent misuse and overuse), and developing new antibiotics and diagnostics tests.