US sees record STD cases, rising gonorrhea resistance

Preliminary data released yesterday by the US Centers for Disease Control and Prevention (CDC) show the number of sexually transmitted diseases (STDs) diagnosed in the United States hit a record high in 2017, marking a fourth straight year of "steep and sustained" increases.

The CDC data also highlighted rising resistance to one of the two antibiotics in the dual therapy for gonorrhea, a development that threatens the last remaining effective treatment for the disease.

"After decades of declining STDs, in recent years, we've been sliding backwards," Gail Bolan, MD, director of the CDC's Division of STD Prevention, said in a telephone briefing. "It is important for partners to come together to combat STD increases and the threat of antibiotic-resistant gonorrhea."

The data, presented yesterday at the National STD Prevention Conference in Washington, DC, show that nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in 2017, surpassing the previous record, set in 2016, by 200,000 cases. The combined number of STDs rose by 31% from 2013 through 2017, up from 1.8 million.

Over the 5-year period, primary and secondary syphilis rose by 76% (from 17,375 to 30,644 cases) and gonorrhea increased by 67% (from 333,004 to 555,608 cases), nearly doubling among men. Chlamydia, the most commonly reported STD, rose by 22% (from 1,401,096 to 1,708569 cases), with 45% of cases occurring in 15- to 24-year-old women.

Rising azithromycin resistance

To date, there have been no reports in the United States of gonorrhea treatment failure. But while the CDC-recommended dual therapy of azithromycin and ceftriaxone remains effective for treating gonorrhea infections, laboratory testing of gonorrheal lab specimens found that resistance to azithromycin increased from 1% in 2013 to more than 4% in 2017.

Azithromycin was added to the treatment regimen in 2015 to help delay development of ceftriaxone resistance. But the CDC warned that rising resistance to azithromycin will eventually "wear down" the effectiveness of ceftriaxone.

"Though not surprising, the finding adds to the complexities of gonorrhea treatment, because preserving the effectiveness of ceftriaxone becomes more difficult," Bolan said.

Bolan also explained that azithromycin-resistant genes in some gonorrhea bacteria could cross over into strains with reduced susceptibility to ceftriaxone, potentially leading to the emergence of a strain that doesn't respond to either drug. Serious health problems, including pelvic inflammatory disease and infertility, can result if the disease goes untreated.

"Our nation urgently needs additional treatment options for gonorrhea," Bolan said.

Although Bolan and others on the call noted that many factors contribute to rising STDs and the emergence of antibiotic-resistant gonorrhea, David Harvey, MSW, executive director of the National Coalition of STD Directors, argued that the problem is linked in part to cutbacks in state and federal funding for public health and STD prevention programs. Harvey called for more funding to help state and local STD programs confront the issue. 

"It is time that President Trump and Secretary Azar declare STDs in America a public health crisis," Harvey said. "What goes along with that is emergency access to public health funding to make a dent in these STD rates and to bring these rates down and to ensure that all Americans get access to the healthcare that they need."

See also:

Aug 28 CDC press release

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