Common Gonorrhea Drugs Don't Work

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Because of growing cases of drug-resistant strains of gonorrhea, the government is expected to announce this week that common treatments against the sexually transmitted disease no longer work and other drugs should be used, top experts said Monday.

The Centers for Disease Control and Prevention plans to announce Thursday new recommendations for treating gonorrhea, said spokeswoman Jessica Frickey, but she declined to give details.

Two health officials who worked with the CDC on its new gonorrhea guidelines told The Associated Press that a different antibiotic will be recommended.

The class of antibiotics commonly used to treat gonorrhea, including the popular ciprofloxacin, sold as Cipro, no longer are effective in fighting certain strains of the bacteria, said Dr. Jeffrey Klausner, deputy health officer and director of STD Prevention and Control Services for the San Francisco Department of Public Health.

Cipro has been used for at least four years to fight gonorrhea, health officials said. In some areas such as in Los Angeles County, however, Cipro-resistant strains cause as many as 12 percent of all cases, said Dr. Peter Kerndt, director of the sexually transmitted disease program for Los Angeles County Public Health.

"What's remarkable for us is how quickly it went up from 1 or 2 percent (in 2001) to 12 percent" currently, Kerndt said.

In place of Cipro, administered as a pill, Klausner said, the CDC is expected to recommend the antibiotic ceftriaxone, which is less convenient because it is administered by injection. Another recommended drug, cefixime, is in pill form but is no longer made in the United States.

In recent years, the government has recommended ceftriaxone for treatment of gonorrhea only in Hawaii and California because of the growing number of Cipro-resistant cases in those states.

Cipro-resistant gonorrhea has apparently spread eastward across the country. A rash of cases among men in Seattle, Chicago, New York and other areas in recent months prompted the CDC to review its national recommendations for treatment, said Dr. H. Hunter Handsfield, director of the STD Control Program for Public Health-Seattle and King County.

Klausner and Handsfield say the new recommendations may present problems for health officials and patients. Cipro was easy for patients to use and commonly found in doctors' offices. However, ceftriaxone must be injected by a doctor or nurse, and clinics do not have ample supplies, Klausner said.

Cipro gained public attention when it was given to people exposed to anthrax-laced envelopes mailed to news media and government offices in 2001. Five people were killed and 17 sickened in the anthrax attacks nationwide.

For two years, California and Washington health officials have been using another antibiotic to treat gonorrhea patients, cefpodoxime, but it isn't in the upcoming CDC guidelines.

"It seems like the white knight for this problem, but the CDC felt uncomfortable making it a first-line recommended therapy" because of limited clinical trial data, Klausner said. "While the CDC can wait to make a recommendation ... we in public health who run clinics need to treat patients."

But health officials say new drug recommendations eventually will have to be made.

"I think it's inevitable because gonorrhea is a wily organism - it changes and adapts," said Dr. William Wong, medical director and clinic director of the San Francisco City Clinic for the San Francisco Health Department.

By Daniel Yee