In 2009, nearly a quarter of strains tested in a nationwide surveillance project of gonorrhea were resistant to penicillin, tetracycline, fluoroquinolones, or a combination of these antibiotics that are typically used to treat the STD. And early data from 2010 indicate resistance to another type of antibiotic, cephalosporin, is emerging. That's concerning because cephalosporins are the only class of antibiotic left that doctors recommend to treat the disease.
"This may be the harbinger of things to come," Dr. Kimberly Workowski, of the Centers for Disease Control and Prevention Division of STD Prevention, said of the early 2010 data. "The resistance may be getting worse," Workowski told MyHealthNewsDaily.
If resistance to cephalosporins develops, gonorrhea could develop into a superbug, and have a catastrophic effect on our ability to control the disease in the country, researchers say. A superbug is a strain of bacteria that has become resistant to antibiotics and is very difficult to kill. Other examples of superbugs include methicillin-resistant Staphylococcus aureus (MRSA ) and some strains of tuberculosis.
Experts are working on strategies to prevent antibiotic resistance, including treating the disease with several antibiotics at once. They also advocate protected sex and STD screening as ways to reduce the acquisition of gonorrhea.
Emerging antibiotic resistance
Gonorrhea is caused by the bacterium Neisseria gonorrhea and is spread through sexual activity. Individuals with gonorrhea often show no symptoms, but the disease can lead to serious complications, including infertility and chronic pelvic pain in women, and in men epididymitis, a painful condition of the ducts attached to the testicles that may cause infertility if left untreated, according to the CDC. If the bacteria spread to the blood or joints, the condition can be life-threatening, the CDC says.
More than 301,174 cases of gonorrhea were reported to the CDC in 2009, though the agency estimates more than 700,000 people become infected with the disease each year in the United States. It is the second most common infectious disease that is required to be reported to the U.S. government.
Since the 1970s, the bacteria have become resistant to traditional antibiotics, including penicillin and tetracycline. In 1991, resistance to fluoroquinolone started to emerge. Researchers don't recommend treatment with these antibiotics now because, once a bacterium has developed resistance to a drug, that resistance can quickly develop again.
Researchers are seeing the emergence of gonorrhea that's resistant to cephalosporin in South East Asia. Typically, resistant strains from that part of the world migrate over to the U.S., and then spread from West to East, Workowski said.
"The concern is that history tends to repeat itself," Workowski said. "It's following the same pattern that's happened before."
How to prevent resistance
To prevent the emergence of cephalosporin resistance, the CDC is now recommending the disease be treated with an injectable form of cephalosporin as well as another type of antibiotic, such as azithromycin or doxycycline.
The CDC, in collaboration with the National Institutes of Health, is also working to identify other drugs that might be used to treat gonorrhea cost-effectively, including drugs that target the bacteria in different stages of the life cycle, Workowski said.
The organization is also working to develop a response plan in case of an outbreak, Workowski said.
Pass it on: Gonorrhea could become a lot harder to treat if the bacteria that cause the disease develop resistance the last class of antibiotics we have to combat it.