Can Gonorrhea Treatment Be Guided by Resistance Testing?

The use of a genotypic assay that detects the absence of a gyrase subunit A serine 91 codon mutation, which confers resistance to fluoroquinolones, allowed for the use of oral ciprofloxacin for treatment of culture-positive gonorrhea.

Antimicrobial resistance in Neisseria gonorrhea is a public health emergency. Injectable third-generation cephalosporins are the only reliable treatment option; 250 mg of ceftriaxone intramuscularly plus 1 g azithromycin orally is the treatment recommended by the CDC. Oral fluoroquinolones such as ciprofloxacin offer an alternative therapy in those who don't have resistance organisms. However, because nearly 14% of gonorrhea samples were resistant to ciprofloxacin, in 2007 the CDC stopped recommending fluoroquinolones as empiric treatment for gonorrhea. Ciprofloxacin resistance in N. gonorrhea is conferred by a single-point mutation in the gyrase A gene. Investigators have now prospectively tested the clinical efficacy of a single oral 500-…

Reviewing Author

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Can Gonorrhea Treatment Be Guided by Resistance Testing?

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Reviewing Author