Gonorrhoea: Resistance emerging to common drugs

Reepa Agrawal
18 Dec, 2018

In line with the drug resistance report presented on pediatriconcall.com last month, we report one more emerging resistance pattern to the disease agent Neisseria gonorrhoea.

In 2015, dual therapy was recommended by CDC for treatment of gonorrhoea post emergence of resistance to fluoroquinolone class of drugs. This dual therapy consisted of 250 mg of single dose intramuscular ceftriaxone alongwith 1g oral azithromycin in adults diagnosed with gonorrhea. Now CDC findings released recently show resistance to azithromycin is also rising in laboratory analysis (from 1 percent in 2013 to more than 4 percent in 2017). This is a matter of concern as the disease is a highly prevalent sexually transmitted disease all over the world. There has been a 67 percent increase of cases of gonorrhoea from 333,004 to 555,608 cases according to CDC preliminary 2017 data. Between the years 2007 and 2017, a total of 34.9 million episodes of sexually transmitted infections and reproductive tract infections (STIs/RTIs) were treated in India.

Gonorrhoea can be transmitted to neonates from their mothers during delivery. This can lead to ophthalmia neonatarum, sepsis and fatal disseminated gonococcal infection in infants. Hence the need of proper treatment of pregnant women and their partners alongwith prophylaxis for the neonates. Erythromycin (0.5%) ophthalmic ointment in each eye in a single application at birth to the neonate is recommended for prophylaxis against ophthalmia neonatarum which can even cause blindness. Presumptive treatment with ceftriaxone 25-50 mg/kg IV or IM in a single dose (max dose 125 mg) is recommended for infants born to mothers with active gonorrheal infection. All such neonates should be evaluated for active infection and if present ceftriaxone 25–50 mg/kg/day IV or IM as a single daily dose for 7 days is recommended, with extension to a duration of 10–14 days if meningitis is documented. Other drug that can be used is cefotaxime 25 mg/kg IV or IM every 12 hours for 7 days, with extension to duration of 10–14 days if meningitis is documented in the neonate. There is no data which suggests dual therapy use in neonates or children. Children may also develop gonorrhea especially in cases of sexually abuse hence one must be alert in terms of abuse whenever a child is diagnosed with gonorrhea.

At present ceftriaxone is working against gonorrhea but there are reports that the azithromycin resistant gene may cross over and eventually a strain resistant to ceftriaxone may develop in the future. It should be noted that cefixime, another cephalosporin no longer works against it. There is an urgent need to identify and develop more drugs to combat diseases.

Now the onus lies on the society and health care workers to impart health education especially on the use of condoms and other barrier contraceptives to sexually active teenagers and adults to prevent transmission of sexually transmitted diseases including gonorrhoea.


Centers for Disease Control and Prevention (CDC)
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