Doctors in Hawaii identified the first cluster of gonorrhea cases to show strong resistance to both antibiotics most commonly used to treat the disease, according to a report from the US Centers for Disease Control and Prevention, raising concerns it could eventually become untreatable with currently-available drugs.
Seven patients sought treatment for gonorrhea in Honolulu earlier this year, infected with strains of the disease that resisted the antibiotic azithromycin at high levels and experienced decreased susceptibility to ceftriaxone. Doctors were ultimately able to treat them using the drugs — the only viable treatment options available — but officials expressed concern over the number of cases and the pattern of resistance.
"Our last line of defense against gonorrhea is weakening," Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said in a press release on Wednesday. "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."
Gonorrhea is the second most common reported disease in the country, with around 350,000 cases registered each year. Experts have grown increasingly concerned about the potential for it to develop complete resistance to antibiotics, the last defense treatment options.
In July, the CDC analyzed state by state data and uncovered evidence indicating azithromycin resistance was developing. At the time their analysis found those cases were still susceptible to ceftriaxone. The news out of Hawaii, however, changes that narrative.
"Hawaii is on the front line for antibiotic-resistant gonorrhea – we've been one of the first states to see declining effectiveness of each drug over the years," said Dr. Alan Katz, professor of public health at the University of Hawaii.
Katz said the weakened impact of the drugs has made healthcare workers in the state more vigilant, which he said put them in the position to pick up on the resistant cluster early and treat it. Even still, he said "the future risk of gonorrhea becoming resistant to both of the recommended therapy medications in the United States is troubling."
Currently, the combination of both antibiotics is still effective for treating gonorrhea and clinical studies are underway for an experimental oral antibiotic that would offer a much-needed alternative. In the meantime, the CDC is urging medical professionals to report any treatment challenges to both their local health officials and the federal agency.