boston.com your connection to The Boston Globe

Drug-resistant gonorrhea spreading in US, officials say

WASHINGTON -- Antibiotic-resistant gonorrhea is spreading rapidly across the United States, federal health officials reported yesterday, raising alarm about doctors' ability to treat the common sexually transmitted infection.

New data from 26 US cities show the number of resistant gonorrhea cases is rising dramatically, jumping from less than 1 percent of all gonorrhea cases to more than 13 percent in less than five years, the Atlanta-based Centers for Disease Control and Prevention reported.

In response, the CDC advised doctors treating gonorrhea to immediately stop using ciprofloxacin, marketed as Cipro, and other antibiotics in its class, which have been the first line of defense against the disease, and resort to an older class of drugs to ensure patients are cured and do not spread the stubborn infection.

"We've lost the ability to use what had been the most reliable class of antibiotics," said John M. Douglas Jr., who heads the CDC's division of sexually-transmitted disease prevention. "This is necessary to protect both public and private health."

The development is alarming, Douglas and other specialists said, because gonorrhea tends to develop resistance to antibiotics quickly, and doctors will be powerless to treat it if that happens with the remaining class of drugs.

"We still have one effective class, but now it's the only one we've got," Douglas said. "This raises the possibility that we may slip into a situation where we have no highly reliable remedies."

The emergence of resistant gonorrhea marks the latest common pathogen to have shifted from an easily treated infection to a resistant form that is suddenly far more dangerous.

"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few," said Henry Masur, president of the Infectious Disease Society of America.

Gonorrhea's resistance was probably caused by the same problem that led to resistance of other organisms -- the casual use of antibiotics in the United States and overseas, which causes pathogens to mutate, Douglas and others said.

"People will take these drugs for many reasons, like if they just have a cold, stimulating resistance to bacteria they don't know they have," Douglas said.

The emergence of resistant gonorrhea and other disease-causing agents is occurring as efforts to develop new antibiotics are flagging because of a lack of interest by the pharmaceutical industry, he said.

"We'll have a major problem on our hands if we don't develop new antibiotics," Douglas said.

Gonorrhea is the second-most-common sexually transmitted disease in the United States after chlamydia, infecting more than 700,000 Americans each year. The highest reported rates occur among sexually active teenagers, young adults, and African-Americans. If untreated, the disease -- which usually does not produce symptoms until the later stages -- can lead to sterility and potentially life-threatening complications.

Resistant strains of the bacteria that cause gonorrhea were first detected in Asia. Resistant gonorrhea then apparently spread to Hawaii and California, before emerging elsewhere in the United States, first among gay men.

In response, the CDC recommended that doctors stop using Cipro and other drugs in its class, known as fluoroquinolones, to treat gonorrhea in California and Hawaii, and among gay men nationwide.

The CDC is recommending that doctors use a class of antibiotics known as cephalosporins, in particular the drug ceftriaxone, which is given by injection, making its use more painful and complicated. Doctors do not typically stock the shots, and patients who are allergic to penicillin often cannot use the drugs.

SEARCH THE ARCHIVES