STD Quarterly

Gonorrhea rates drop; stay focused on spread

Efforts to lower the rates of gonorrhea in the United States are dipping figures to all-time lows, but work remains to erase racial disparities and combat growing drug resistance to the sexually transmitted disease (STD).

While gonorrhea rates dropped to 116.2 cases per 100,000 population between 2002 and 2003, African Americans remained most heavily affected by gonorrhea, with reported rates of disease 20 times higher than for whites, states John Douglas Jr., MD, director of the Centers for Disease Control and Prevention (CDC) Division of STD Prevention in the agency’s National Center for HIV, STD, and TB Prevention. Improved screening and treatment of at-risk individuals are critical to reducing the impact of gonorrhea, especially among African Americans, he states.

According to the CDC, gonorrhea is the second most commonly reported infectious disease in the United States, with 335,104 cases reported in 2003. An estimated 718,000 new infections occur each year.1 New figures published in the agency’s Sexually Transmitted Disease Surveillance, 2003 indicate that the national gonorrhea rate dropped to an all-time low, decreasing by 4.8% between 2002 and 2003.2 (See the resource listing below for instructions on how to access the publication. )

State figures in the new report vary widely, ranging from 264.4 per 100,000 people in Louisiana to 5.1 per 100,000 people in Idaho. Forty-two states report rates above the goal of 19.0 cases per 100,000 population, the target listed in Healthy People 2010, a comprehensive set of national disease prevention and health promotion objectives developed through the Department of Health and Human Services.

Understand the disease

Caused by the bacterium Neisseria gonorrhoeae, gonorrhea can cause infection in the female reproductive tract as well as the urethra in men and women. It also can grow in the mouth, throat, eyes, and anus. Infection is spread through contact with the penis, vagina, mouth, or anus; ejaculation does not have to occur for the STD to be transmitted or acquired. It also can be spread from mother to baby during delivery.3

Gonorrhea is easily cured; untreated cases can lead to serious health consequences. In men, untreated gonorrhea can cause epididymitis, which can lead to infertility. For women, untreated gonorrhea can develop into pelvic inflammatory disease, which can translate into chronic pelvic pain, ectopic pregnancy, and infertility. Gonorrhea acquisition also increases the risk of HIV transmission in men and women.

The CDC lists the following first-line treatment options:

  • Cefixime 400 mg orally in a single dose;
  • Ceftriaxone 125 mg IM in a single dose;
  • Ciprofloxacin 500 mg orally in a single dose;
  • Ofloxacin 400 mg orally in a single dose; or
  • Levofloxacin 250 mg orally in a single dose.3

The original manufacturer of cefixime, Wyeth Pharmaceuticals in Collegeville, PA, discontinued U.S. production in 2002. However, in 2004 the FDA granted Lupin Pharmaceuticals of Baltimore approval for manufacture of cefixime suspension 100 mg/5 ml, as well as cefixime in 400 mg tablet form. Lupin has relaunched its product under the same brand name, Suprax. (See the resource below for company contact information.)

If chlamydia is not ruled out, clinicians should use dual therapy in gonorrhea treatment, adding azithromycin, 1 g orally in a single dose, or doxycycline, 100 mg orally twice a day for seven days, to the gonorrhea treatment regimen. Such dual treatment has become more commonplace since patients infected with N. gonorrhoeae often are coinfected with C. trachomatis.3

Be vigilant about use of the fluoroquinolones ciprofloxacin, ofloxacin, and levofloxacin; these drugs are not recommended for treatment of gonorrhea infections acquired in Hawaii, California, Asia, the Pacific, and in other areas with increased prevalence of fluoroquinolone resistance. Through the CDC’s nationwide Gonococcal Isolate Surveillance Project (GISP), CDC found that the prevalence of fluoroquinolone-resistant gonorrhea (QRNG) more than doubled from 0.4% in 2002 to 0.9% in 2003, says Stuart Berman, MD, ScM, chief of the epidemiology and surveillance branch in the CDC’s Division of STD Prevention.

"Most notably, QRNG increased among MSM [men who have sex with men] from 1.8% in 2002 to 4.9% in 2003," says Berman. "Based on these and other available data, in April 2004, CDC recommended that fluoroquinolones no longer be used as first-line treatment for gonorrhea in MSM."

References

1. Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.

2. Centers for Disease Control and Prevention. Sexu ally Transmitted Disease Surveillance, 2003. Atlanta: U.S. Department of Health and Human Services; September 2004.

3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR 2002; 51(RR-6):1-80.

Resources

  • To review the statistics in the Sexually Transmitted Disease Surveillance, 2003 on-line, go to the CDC’s National Center for HIV, STD, and TB Prevention web site, www.cdc.gov/std. Click on "2003 STD Surveillance Report."

For more information on Suprax (cefixime), contact:

  • Lupin Pharmaceuticals, Harborplace Tower, 111 S. Calvert St., 21st Floor, Baltimore, MD 21202. Telephone: (800) 826-9556 or (410) 576-2000. Fax: (410) 576-2221. E-mail: suprax@lupinusa.com. Web: www.suprax.info.