Increased resistance of Neisseria gonorrhoeae to fluoroquinolones and review of recommendations for the treatment of gonorrhea

In the United States, 700 to 800,000 people are infected each year with Neisseria gonorrhoeae. Since 1993, recommendations from the United States Centers for Disease Control and Prevention (CDC) for the treatment of gonorrhea have included fluoroquinolones. Treatment with fluoroquinolones is widely used due to the low cost and the sufficiency of a single oral administration. However, due to the growing resistance of N.gonorrhoeae to fluoroquinolones in Asia, the Pacific Islands (including Hawaii) and California, fluoroquinolones are no longer recommended for the treatment of gonorrhea in these regions. There has been an increase in the number of fluoroquinolone-resistant gonococci isolated from gay men in Massachusetts, New York, and the 30 other regions that were included in the 2003 Giococcal Isolate Monitoring Project (GISP) CDC recommends no longer consider fluoroquinolones as the drugs of choice for the treatment of gonorrhea in this category of patients. The results of this study suggest that the prevalence of fluoroquinolone-resistant gonococci in the gay male population will soon cross the 5% barrier. This level of resistance is often considered as a criterion for modifying the treatment regimen. In the absence of a sensitivity test, fluoroquinolones should not be used for suspected or confirmed gonococcal infections in gay men in the United States.

According to the CDC's recommendations, homosexuals with gonorrhea, as well as people infected in the territory with high resistance levels, should receive the following treatment: ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally and spectinomycin 2 g intramuscularly is considered an alternative treatment option. Spectinomycin can be used for the urogenital or anal localization of a gonococcal infection, but its use is not effective enough to treat pharyngeal gonorrhea.

Physicians should be careful not to detect ineffective therapy, inform patients of the importance of seeing a doctor if symptoms persist, and be prepared to conduct cultural studies in such cases. Sensitivity culture studies should be performed in case of ongoing infection after treatment with fluoroquinolones.

The recommendations for the treatment of gonorrhea in heterosexual patients are currently unchanged.