Threat of untreatable gonorrhea is increasing, new data show

U.S. health officials have identified a cluster of gonorrhea infections that show sharply increased resistance to the last effective treatment available for the country’s second most commonly reported infectious disease.

The findings from a cluster of Hawaii cases, presented Wednesday at a conference on prevention of sexually transmitted diseases, represent the first cases in the United States that have shown such decreased susceptibility to the double-antibiotic combination used when other drugs have failed. If the bacteria continue to develop resistance, that end-of-the-line therapy ultimately will fail, and an estimated 800,000 Americans a year could face untreatable gonorrhea and the serious health problems it causes, health officials said.

This latest news about antibiotic resistance comes on the same day as world leaders gathered at an unusual meeting at the United Nations to address the rising threat posed by superbugs, microbes that can’t be stopped with drugs. Leaders adopted a joint declaration committing them to take a broad approach to address the root causes of antimicrobial resistance, especially in human health, animal health and agriculture.

Countries called for better use of existing tools to prevent infections in humans and animals, including farmed fish. Norway’s prime minister spoke about how her country has been vaccinating every single “baby salmon, just like small kids,” and as a result, has cut antibiotic use in one of its principal foods and exports to virtually zero.

Common and life-threatening infections like pneumonia, gonorrhea and tuberculosis are increasingly becoming untreatable because of antibiotic resistance, they said.

In the United States, drug-resistant gonorrhea already is one of the country’s three most urgent superbug threats, according to the Centers for Disease Control and Prevention. In each case, as with other diseases, overexposure to antibiotics has allowed the particular germ to more rapidly develop resistance.

CDC warned this summer that evidence of gonorrhea’s resistance to one of the last-resort drugs, azithromycin, was emerging nationwide. But it said the other antibiotic, ceftriaxone, was still effective.

That’s why the latest findings are so distressing for health officials. It means current treatment options are in jeopardy, said Gail Bolan, director of CDC’s division of STD prevention. “What’s unique about this cluster now identified in Hawaii is that these strains we’ve really never seen before,” she said.

Laboratory tests of the gonorrhea samples collected from seven people in Honolulu in April and May showed resistance to azithromycin at “dramatically higher levels” than typically seen in the United States, according to researchers from Hawaii’s state health department. Four of the seven samples also showed increased resistance to ceftriaxone.

Hawaii is on the front line for antibiotic-resistant gonorrhea, health officials say. That has made the state monitor resistance patterns closely so they were able to catch this cluster of cases early. Although the patients were treated successfully with the recommended two drugs, and no additional cases were identified, officials are worried that the resistance pattern and cluster of cases indicate the strain was able to spread.

Many people don’t actually know they’re infected with gonorrhea because they have no symptoms. As a result, the disease goes undetected and untreated, which can cause a range of problems. Women risk chronic pelvic pain, life-threatening ectopic pregnancy and even infertility. And for both women and men, infection also increases the risk of contracting and transmitting HIV.

History has shown that gonorrhea bacteria have been able to outsmart and become resistant to a long list of antibiotics that includes penicillin, tetracycline, and fluoroquinolones. CDC has been closely monitoring early warning signs of resistance not only to azithromycin but also to cephalosporins, the class of antibiotics that includes ceftriaxone.

But now, officials say there are no backup options that are highly reliable, widely available, affordable and well tolerated. There is an experimental oral antibiotic being tested in a clinical study that may offer a possible new treatment, officials said.

At the conference, researchers from Louisiana State University presented data about a drug under development that they said was generally safe and effective in treating gonorrhea in a phase 2 clinical trial. Those results will need to be confirmed in a large-scale clinical trial.

The experimental drug works differently from any currently marketed antibiotic. It is a single-dose oral therapy, and could be used as an alternative to ceftriaxone injection. In a randomized controlled trial reported Wednesday, researchers treated 179 people with gonorrhea using the experimental drug (at two different dosages) alone or ceftriaxone alone. Virtually all the patients receiving the experimental drug were cured.