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NEW ORLEANS -- Routine surveillance in southern Ohio revealed a rapid increase this year in gonorrhea with resistance or reduced susceptibility to some of the drugs used to treat it, researchers reported here.
In 2016, 5.9% of tested gonorrhea isolates showed reduced susceptibility to azithromycin and 15.7% showed resistance to ciprofloxacin -- up from less than 2% between 1996 and 2015, according to , of Wright State University in Dayton, Ohio.
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- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
However, there was no detected decrease in susceptibility to ceftriaxone, one of the two drugs in the , Herchline reported in a late-breaker session at IDWeek, a joint meeting of the (IDSA), the (SHEA), the (HIVMA), and the (PIDS).
"It complicates your ability to treat infections, so something that was simple becomes a little more complicated, and things that are more complicated are more of a challenge," , of the CDC in Atlanta, told reporters at a press briefing. "These trends are not ones that we want to see propagated further."
"It used to be that we could give a pill and that's very easy," added , of the University of Pennsylvania in Philadelphia. "Now we have to use an injection, which is more complicated. You have to have a refrigerator, you have to have needles, and people don't like to get injections in the butt."
Drug-resistant gonorrhea is a growing threat in the U.S. and worldwide. In September, public health officials in Hawaii reported the first cluster of gonorrhea cases with reduced susceptibility to both drugs in the current recommended regimen.
According to the , the recommended regimen for treatment of uncomplicated gonorrhea is a single 250 mg intramuscular injection of ceftriaxone plus a single 1 g oral dose of azithromycin.
Due to the emergence of resistance starting in the 1990s, the CDC as a standard treatment for gonorrhea.
Herchline presented data from the Dayton and Montgomery County public health department's sexually transmitted infections (STIs) clinic, which receives approximately 10,000 visits per year. All clients are tested for gonorrhea, chlamydia, and syphilis, and the first 10 gonococcal specimens collected each month are tested for drug susceptibility.
The department participates in the CDC's , which performs resistance testing on gonorrhea specimens from STI clinics in about 30 cities.
From 1996 to 2008, the Ohio clinic tested gonorrhea for resistance to ciprofloxacin, tetracycline, azithromycin; from 2011 forward they stopped testing for tetracycline and added ceftriaxone.
Ciprofloxacin resistance was defined as a minimum inhibitory concentration (MIC) of no more than 1 µg/mL. MIC cutoffs for decreased susceptibility to ceftriaxone and azithromycin were no more than 0.125 µg/mL and no more than 2 µg/mL, respectively.
Altogether, the Ohio clinic tested 981 gonorrhea samples obtained since 1996, including 51 collected from January to July 2016.
No gonorrhea isolates showed reduced susceptibility to azithromycin during 1996-2014, but the proportion rose to 1.9% in 2015 and 5.9% in 2016. Less than 2% of isolates showed resistance to ciprofloxacin from 1996 through 2015, increasing to 15.7% in 2016. No isolates tested from 2011 through 2016 showed reduced susceptibility to ceftriaxone.
The CDC's recommended regimen will still be effective for most patients, Herchline suggested. Ciprofloxacin is now seldom used to treat gonorrhea, though it is sometimes prescribed for people with allergies to the recommended drugs.
"We try to determine if there's significant risk to giving ceftriaxone," Herchline said. "Most patients, when you drill down, really it's safe to give them ceftriaxone. So we've not used [ciprofloxacin] much and now we're looking at other alternatives."
Disclosures
Herchline and co-authors disclosed no relevant relationships with industry.
Primary Source
IDWeek
Herchline T, et al "Rapid emergence of resistance among fonorrhea isolates in Southern Ohio" IDWeek 2016; Abstract LB-8.