Treatment options narrow for gonorrhea

ATLANTA — The sexually transmitted disease gonorrhea is among the superbugs resistant to common antibiotics, causing U.S. health officials to recommend wider use of a different class of drugs to avert a public-health crisis.

The resistant form accounts for more than one in every four gonorrhea cases among heterosexual men in Philadelphia and nearly that many in San Francisco, according to a survey that led to Thursday's recommendation by the Centers for Disease Control and Prevention (CDC).

Gonorrhea, which is believed to infect more than 700,000 people in the United States each year, can leave men and women infertile and puts people at higher risk of getting the AIDS virus.

Since the early 1990s, a class of drugs known as fluoroquinolones has provided a relatively easy cure. These antibiotics, taken as tablets, include the drug Cipro.

But more and more gonorrhea cases are resistant to those drugs, and officials at the CDC for the first time are urging doctors to stop using fluoroquinolones and switch to cephalosporins, a different class of antibiotics, to treat everyone.

Those drugs — which include the generic ceftriaxone or brand name Rocephin, made by Swiss drug maker Roche Holding — must be given as a shot and aren't as readily stocked as Cipro on most doctors' shelves.

"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Dr. Henry Masur, president of the Infectious Disease Society of America. "To make a bad problem even worse, we're also seeing a decline in the development of new antibiotics to treat these infections."

The CDC made the new recommendation after discovering that nearly 7 percent of gonorrhea cases among heterosexual men in a survey of 26 U.S. cities last year were drug-resistant. In 2001, about 0.6 percent of gonorrhea cases among heterosexual men were drug-resistant.

"That leaves us with a single class of highly effective antibiotics," said Dr. John Douglas Jr., director of the CDC's division of sexually-transmitted disease (STD) prevention. Other experts called the situation perilous.

"We are running out of options to treat this disease," added Douglas, who said there are "no new drugs for gonorrhea in the drug-development pipeline."

In King County, samplings of new gonorrhea cases found that about 34 percent of men and 18 percent of women had fluoroquinolone-resistant gonorrhea. That includes gay men, who have a higher rate of the drug-resistant strain than heterosexuals.

County public-health clinics and the vast majority of private physicians have been prescribing a cephalosporin for gonorrhea since 2004, said Dr. Matt Golden, director of STD control for Public Health — Seattle & King County. State officials began advising doctors to use the drugs in 2004.

The health officials said that even then they were seeing an increase of fluoroquinolone-resistant gonorrhea, first in gay men and then in heterosexuals.

"We felt like we saw the handwriting on the wall," Golden said.

Overall, King County gonorrhea cases increased about 8 percent in 2006, especially among women. Statewide, they jumped about 13 percent, notably in rural areas, said Mark Stenger, STD epidemiologist for the state Department of Health.

The technique used nationally to determine resistance was developed by the late Dr. William Kirby, a professor of medicine at the University of Washington.

Gonorrhea, spread through sexual contact, is the second most commonly reported infectious disease in the United States, trailing only chlamydia, which the CDC says affects more than 2.1 million people yearly in the United States.

Seattle Times staff reporter Warren King contributed to this report.