Earlier this year, the CDC published data that raised concerns about the emergence of antibiotic-resistant gonorrhea. Now, a newly identified cluster of highly resistant gonorrhea infections in the United States has health officials urging for better treatment options.
For the first time, a cluster of gonorrhea infections with both decreased drug susceptibility and high-level resistance to recommended antibiotic treatments has been identified. Researchers from the Hawaii State Department of Health uncovered highly azithromycin-resistant gonorrhea infections in gonorrhea isolates collected from 7 individuals in Honolulu. The study conducted in April and May 2016 also revealed a decreased susceptibility to ceftriaxone in isolates gathered from 5 of those individuals.
A dual therapy made up of a single shot of ceftriaxone and oral dose of azithromycin is the CDC-recommended treatment regimen for this common sexually transmitted infection (STI).  Although there are no confirmed failures of the treatment in the United States, reduced drug susceptibility can indicate an emerging resistance to these antibiotics. The Hawaii investigation is the first to show emerging azithromycin resistance and reduced drug susceptibility to both of the agents. 
“Our last line of defense against gonorrhea is weakening,” Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release. “If resistance continues to increase and spread, current treatment will ultimately fail and 800,000 Americans a year will be at risk for untreatable gonorrhea.”
In the event of increasing antibiotic resistance, the CDC typically revises its treatment guidelines to include other more effective and available medication options. In this case, however, no effective alternative treatment options are currently available.
Despite these concerns, a new experimental drug hints at a promising future for gonorrhea treatment. The novel oral antibiotic, named ETX0914, is a single-dose therapy currently undergoing tests in a clinical study for the treatment of uncomplicated gonorrhea. Preclinical evaluations of the drug by CDC researchers showed that it was active in the laboratory against antibiotic-resistant strains of gonorrhea, and early clinical trials have so far had positive results. The findings were presented on September 21, 2016, at the STD Prevention Conference.
There are many ways that health care providers can prevent antibiotic resistance, but fighting resistance to gonorrhea infections is difficult because of the limited therapeutic options available. In order to stave off the emergence of untreatable gonorrhea, continued research into effective medications for treatment is necessary. Ongoing efforts to maintain routine gonorrhea testing and treatment services, as well as enhancing systems to monitor for emerging drug resistance, can help rapid detection and response to highly resistant outbreaks.
“In Hawaii, the system worked,” said Dr. Mermin. “Front-line providers diagnosed and treated infections, public health officials quickly detected resistance, and we were able to use cutting-edge lab technologies to track its spread and treat people who were linked to the cluster.”
The CDC’s recommended treatment of combined azithromycin and ceftriaxone is still effective for use, and the agency encourages health care providers to continue to adhere to the dual therapy outlined in its most recent STD Treatment Guidelines