Neisseria gonorrhoeae has been remarkably adept at acquiring and maintaining resistance to antimicrobial drugs used for treatment, such as penicillin, tetracyclines, and fluoroquinolones (e.g., ciprofloxacin).
After first spreading in Hawaii and California during the late 1990s and early 2000s, ciprofloxacin-resistant gonococcal strains became increasingly prevalent in the United States during the 2000s. By 2007, the Centers for Disease Control and Prevention (CDC) no longer recommended ciprofloxacin or other fluoroquinolones for treatment of gonorrhea, which make the cephalosporins cefixime or ceftriaxone the only remaining recommended treatment option.

Researchers analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level. They analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991–2006. Researchers found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection.
These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.

CDC now recommends dual therapy with ceftriaxone (an injectable cephalosporin) and a second antimicrobial drug as the only remaining recommended first-line treatment option for gonorrhea. However, the possible emergence and spread of cephalosporin resistance could eventually threaten the effectiveness of this regimen and pose a major public health challenge.

For more information
Centers for Disease Control and Prevention

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