CDC Issues New First-Line Treatment Recommendations for Gonorrhea Among Men Who Have Sex With Men
The class of antibiotics known as fluoroquinolones should no longer be used as a first-line treatment for the sexually transmitted disease gonorrhea among men who have sex with men, according to revised recommendations published in the April 30 issue of CDC's Morbidity and Mortality Weekly Report, the Atlanta Journal-Constitution reports (McKenna, Atlanta Journal-Constitution, 4/30). CDC since 1993 has recommended the use of fluoroquinolones, such as Cipro, to treat gonorrhea because the drugs are inexpensive and involve a single oral dose (Ratelle et al., MMWR, 4/30). However, CDC is changing its recommendations based on preliminary data published in MMWR that show an increase in the number of drug-resistant gonorrhea cases reported in 2003 (CDC release, 4/29). A recent study of data from STD clinics in 23 U.S. cities showed that the number of fluoroquinolone-resistant gonorrhea cases more than doubled between 2002 and 2003. The occurrence of drug-resistant gonorrhea was highest among MSM, increasing from 1.8% in 2002 to 4.9% in 2003 (Stein, Washington Post, 4/30). Because nearly 5% of gonorrhea cases among MSM are drug-resistant -- the resistance level at which a therapeutic regimen should be changed -- CDC has recommended that fluoroquinolones no longer be used as a first-line treatment for gonorrhea in MSM. In addition, due to an increase in the prevalence of fluoroquinolone-resistant gonorrhea strains in Asia, the Pacific Islands and California, CDC no longer recommends the use of fluoroquinolones to treat gonorrhea acquired in those areas (MMWR, 4/30). Gonorrhea can cause serious health problems, including infertility in both men and women, if left untreated (McVicar, South Florida Sun-Sentinel, 4/30).
The increase in the prevalence of drug-resistant gonorrhea may have been fueled by individuals who traveled to areas that have seen recent increases in drug-resistant cases, including Asia, Hawaii, the West Coast, New York City and Massachusetts, according to John Douglas, director of CDC's Division of STD Prevention. He added, "Once it gets within their sex networks, it's easily transmitted" (Tasker, Miami Herald, 4/30). Officials called the increase in drug-resistant cases among MSM "alarming" because it offers additional evidence that MSM may be engaging in risky sexual behavior, according to the Post. Syphilis rates among MSM also have increased, and there are indications that HIV rates among MSM may be rising as well, according to the Post. "Drug-resistant gonorrhea is a rapidly emerging health concern," Douglas said (Washington Post, 4/30). MSM may be "relaxing safe sex practices, using illegal substances such as crystal methamphetamine that disrupt judgment and meeting more sexual partners over the Internet," Douglas said, according to the Washington Times (Howard Price, Washington Times, 4/30). In addition, CDC said that drug-resistant gonorrhea strains among heterosexuals were "likely to increase over time and already might be high enough in some areas to warrant new local treatment recommendations," according to the AP/New York Times (AP/New York Times, 4/30). Because CDC is concerned about the possible spread of drug-resistant strains into the general population -- possibly through men who have sex with both men and women -- CDC has started additional research into gonorrhea among women (Atlanta Journal-Constitution, 4/30). Nearly 80% of gonorrhea cases occur among heterosexuals, and fluoroquinolones remain the first-line treatment for such cases, according to the AP/Times (AP/New York Times, 4/30).