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Background: Over the past 60 years, the gonococcus has developed resistance to each of the recommended therapies; although resistance to the cephalosporins has not been seen in the United States, resistance to oral preparations has been observed in Asia, and is extensive in Japan. Given the limited therapeutic choices available, the emergence of cephalosporin (including ceftriaxone) resistant gonococcal strains (Ceph-R GC) – considered inevitable by many experts -- would be extremely problematic and is a possibility that STD programs should prepare to address.
Objectives: Describe what STD programs should do to prepare for the appearance of a Ceph-R GC in their communities.
Methods: Recommended steps are based on a consultation involving STD program directors, laboratorians, clinicans, and epidemiologists Results: Initially, community providers must be informed about the potential for emergence of Ceph-R GC and appropriate therapeutic alternatives, and be prepared to perform culture and antimicrobial testing for apparent treatment failures. Some STD programs could utilize data from CDC’s Gonorrhea Isolate Surveillance Project (GISP) to track the presence of resistant strains. However, given GISP limitations (ie. selected geographic locales, inherent delays in processing, etc), providers will be critical for monitoring Ceph-R GC in most jurisdictions. When a resistant strain appears in a community, health departments must communicate with their providers, take steps to assess the community prevalence of such resistance, and perform partner management on persons with Ceph-R GC. Given the limited availability of culture and of antimicrobial testing, providing such services will be an organizational challenge. Conclusions: The appearance and dissemination of Ceph-R GC would constitute a major public health concern, one which STD programs are not currently prepared to address. Implications for Programs, Policy, and/or Research: For health departments to be able to deal effectively with the emergence of Ceph-R GC, advanced communication with providers and identification or development of appropriate laboratory capacity is critical.