Treatment in An Era of Dwindling Treatment Options

Declining cephalosporin susceptibility in Neisseria gonorrhoeae coincides with a substantial decline in the development and availability of new antibiotic agents.  This presentation will address current recommendations for treatment of gonorrhea and describe ongoing efforts to develop and evaluate alternative antibiotic options.

Background: Gonorrhea treatment has been complicated by the ability of N gonorrhoeae to develop resistance to many antimicrobials.

Objectives:  Declining cephalosporin susceptibility in Neisseria gonorrhoeae coincides with a substantial decline in the development and availability of new antibiotic agents.  This presentation will address current recommendations for treatment of gonorrhea and describe ongoing efforts to develop and evaluate alternative antimicrobial options.

Methods:  Provide a historical perspective on antimicrobial resistance, discuss the evolution of criteria for gonorrhea treatment, and discuss current treatment recommendations including new directions in treatment.

Results:  The most effective treatment for uncomplicated gonorrhea is ceftriaxone 250 mg intramuscularly and azithromycin 1 gram or doxycycline 100 mg twice daily for seven days orally as combination therapy.

Conclusions: A comprehensive prevention strategy should include enhancement of  international and national surveillance, optimal antimicrobial regimens, implementation of screening recommendations, and prompt and effective treatment of sexual partners. Implications: Effective antimicrobial treatment eradicates infection in the infected individual, prevents transmission, thus reducing disease rates. However, careful attention to all components of a comprehensive prevention strategy is necessary to control gonorrhea.