Gonorrhea

Neisseria gonorrheae has over time developed resistance to sulfonamides, penicillin, tetracyclines and fluoroquinolones. There have now been reports of resistance to oral third-generation cephalosporins in Asian, Australia and elsewhere. Strains with altered cephalosporin susceptibility have caused clinical failures after treatment with oral third generation cephalosporins (cefixime), especially with infection of the pharynx. In fall 2009, HMC gonorrhea lab did observe GC isolates with cephalosporin resistance and for this reason, the following regimens are advised for suspected or confirmed gonorrhea infection:

Ceftriaxone 250 mg IM x 1 (note: higher than standard 125 mg dose) PLUS azithromycin 1000 mg PO x 1 regardless of concurrent Chlamydia

or
Cefexime 400 mg PO x 1 PLUS azithromycin 1000 mg PO x 1 regardless of concurrent Chlamydia

NOTE: Avoid this oral combo however in pharyngeal GC infections as lower cure rates with this treatment compared with anogenital GC infections – possibly due to inadequate tissue levels. IM ceftriaxone plus azithromycin is the preferred treatment of GC in the throat.

Testing: Aptima Combo 2

REFERENCES

Barry, PM and Klausner JD. The use of cephalosporins for gonorrhea: The impending problem of resistance. Expert Opin Pharmacother 2009; 10(4): 555-57.

Lehman JA et. al. Threat to Cefixime treatment for Gonorrhea. Emerging Infect Dis 2007; 13(8): 1275-77.

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