Gonorrhea, caused by Neisseria gonorrhoeae, is the second most commonly reported notifiable disease in the United States, after chlamydia: 468,514 cases in 2016, up 18.5% from 2015. Over time the bacterium has become resistant to most antibiotics used against it, so CDC — after revising its guidance in 2012 and 2015 — recommends two drugs together for uncomplicated gonorrhea:
ceftriaxone 250 mg by injection (IM) plus azithromycin 1 g by mouth
The dual therapy is meant to work better and, potentially, to slow the spread of resistance. How often do patients actually get it?
The data
CDC used the STD Surveillance Network (SSuN), in which health departments follow up a random sample of reported cases — verifying treatment with the diagnosing provider and interviewing patients. Seven jurisdictions had treatment data for at least 90% of completed investigations: Baltimore, California (except San Francisco), Florida, Massachusetts, Multnomah County (Oregon), Minnesota and Philadelphia.
Of 91,719 cases reported there in 2016, 8,393 were sampled and 3,213 fully investigated.
Results
81.3% of patients received the recommended regimen — from 76.7% to 92.0% depending on the jurisdiction.
| Where diagnosed | Got the recommended regimen |
|---|---|
| Family planning / reproductive health clinics | 93.8% (vs 79.5% elsewhere) |
| STD clinics | 90.8% (vs 79.8% elsewhere) |
- No differences by age or race and ethnicity.
- Men who have sex with men were more likely to get it than heterosexual men and women (84.8% vs 79.4%) — partly because more were diagnosed in STD clinics, though specialty clinics did better for both groups.
- Women were slightly less likely than men (79.3% vs 82.5%), but the difference wasn't significant.
18.7% received something else, most often:
| Other regimen | Share of all patients |
|---|---|
| Ceftriaxone 250 mg alone | 5.9% |
| Ceftriaxone (any dose) with doxycycline | 4.4% |
| Azithromycin alone | 3.1% |
Fewer than 0.5% got regimens suggesting a cephalosporin allergy or a complicated infection.
Why it matters
Adherence was high, as in earlier SSuN studies (2006–2008 and 2010–2012) — especially in specialty clinics, pointing to high-quality care there. Providers who see fewer gonorrhea cases may be less familiar with current guidance; the availability of injectable drugs and patient-reported allergies also play a part.
But single-drug treatment is a concern. Azithromycin alone isn't recommended because of rising resistance and treatment failures, and tetracyclines haven't been recommended for gonorrhea since the 1980s because of established resistance. Health departments should find where patients are undertreated and offer training and education — part of any effort to hold back drug-resistant gonorrhea.
Limits: the seven jurisdictions aren't nationally representative (though they reported about 20% of U.S. cases); nonresponding providers may treat differently; allergies and complications weren't recorded; and treatment was missing for 6.7% of sampled cases.
Sources
Based on Emily J. Weston, Kimberly Workowski, Elizabeth Torrone, Hillard Weinstock and Mark R. Stenger, "Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea — STD Surveillance Network, United States, 2016," MMWR, volume 67, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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