Health officials have detected a cluster of gonorrhea infections that demonstrated decreased susceptibility to ceftriaxone and very high-level resistance to azithromycin, according to a presentation by Louisiana State University researchers at the 2016 STD Prevention Conference. 

Ceftriaxone and azithromycin comprise the dual regimen that is the last available effective gonorrhea treatment option. The Centers for Disease Control and Prevention (CDC) recommends a single injection of ceftriaxone and an oral dose of azithromycin to treat gonorrhea. 

Apart from this, an experimental oral antibiotic, ETX0914, is being evaluated in a clinical study that may offer a new single-dose treatment option for this sexually transmitted disease (STD). In a Phase 2 trial (n=179), study subjects were treated with ETX0914 alone (2g or 3g) or ceftriaxone alone. All patients in the ETX0914 3g and 98% of patients in the ETX0914 2g arm were cured.  

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Recent findings from the Hawaii investigation identified the first cluster of cases that demonstrated reduced susceptibility to both of the recommended treatments in the United States. Testing on gonorrhea isolates collected from seven individuals in Honolulu in April/May 2016 showed resistance to azithromycin at significantly higher levels than typically seen. Moreover, isolates from five of the individuals showed decreased susceptibility to ceftriaxone. All of the patients were treated successfully with the dual regimen and no additional cases have been reported since May. 

At this time, the CDC has not reported any confirmed failures of the recommended dual therapy. Gail Bolan, MD, director of CDC’s Division of STD Prevention stated, “Using both drugs ensures patients are cured of infection and prevents further transmission, but to preserve this option, providers should treat infections right away with the combination of azithromycin and ceftriaxone. All health care providers should also promptly report any suspected treatment failure to local health officials and CDC to ensure rapid response to cases or clusters of concern.”

Maintaining investments in routine gonorrhea testing and treatment, enhancing systems that monitor emerging drug resistance, and building rapid detection are all needed to preserve the efficacy of the current regimen as well as the development of more drug candidates. The CDC encourages clinicians to follow to the recommended dual therapy as outlined in CDC’s most recent STD Treatment Guidelines.

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