indicate that higher-than-expected antibiotic concentrations are needed to
stop their growth.
In the United States, reports of apparent failures of infections to respond to
treatment with CDC-recommended therapies should be reported to Robert D.
Kirkcaldy, MD, MPH ([email protected]; 404-639-8659), Surveillance &
Data Management Branch, Division of STD Prevention, Centers for Disease
Control and Prevention, 1600 Clifton Rd. NE, Mailstop E02, Atlanta, GA
30333.
CDC also recommends that isolates from certain infections be submitted to
the Neisseria Reference Laboratory at CDC for confirmation: John Papp,
Ph.D. [email protected]; 404- 639 -3785, Neisseria Reference Laboratory,
Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop
A12, Atlanta, GA 30333. These infections comprise those that do not
respond to CDC-recommended therapy. See pg. 6, Recommended Testing
and Confirmatory Testing for a complete list.
Trends and Treatment
In 1993, ciprofloxacin, a fluoroquinolone, and cephalosporins ceftriaxone
and cefixime were the recommended treatments for gonorrhea. However, in
the late 1990s and early 2000s, ciprofloxacin resistance was detected in
Hawaii and the West Coast, and by 2004 ciprofloxacin resistance was
detected among men who have sex with men (MSM) with gonorrhea. By
2006, 13.8% of isolates exhibited resistance to ciprofloxacin, and
ciprofloxacin resistance was present in all regions of the country, and in the
heterosexual population. On April 13, 2007, CDC stopped recommending
fluoroquinolones as empiric treatment for gonococcal infections for all
people in the United States. The cephalosporins, either cefixime or
ceftriaxone, were the only remaining recommended treatments.
Similar to trends observed elsewhere in the world, CDC has observed recent
worrisome trends of decreasing cephalosporin susceptibility, especially to the
oral cephalosporin cefixime. To preserve cephalosporins for as long as
possible, CDC has since then made the following changes to its STD
Treatment Guidelines:
In 2010, CDC changed its treatment recommendations to recommend dual
therapy for the treatment of gonorrhea and increased the recommended dose
of ceftriaxone to 250 mg.