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CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea

February 23, 2013

CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea
Source: Morbidity and Mortality Weekly Report (CDC)

Although gonorrhea has afflicted humans for centuries, and the causative bacterium, Neisseria gonorrhoeae, was identified more than a century ago, gonorrhea remains a public health problem in the United States. Gonorrhea is the second most commonly reported notifiable infection in the United States; >300,000 cases were reported in 2011 (1). In the United States, health inequities persist; the incidence of reported gonorrhea among blacks is 17 times the rate among whites, likely because of structural socioeconomic factors (1,2).

Infection with N. gonorrhoeae is spread through sexual contact and, depending on the anatomic site of exposure, can cause acute urethritis, cervicitis, proctitis, or pharyngitis. However, most cases of gonorrhea are asymptomatic, particularly cervical, pharyngeal, and rectal infections. Untreated or inadequately treated gonorrhea can facilitate human immunodeficiency virus (HIV) transmission and cause serious reproductive complications in women, such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Other severe complications, including disseminated gonococcal infection and neonatal conjunctivitis and blindness, still occur in resource-limited settings, but are now rare in the United States. Empiric antimicrobial therapy is used for treatment of gonorrhea. Antimicrobial susceptibility testing generally is not routinely available in clinical practice, and early diagnosis and effective antimicrobial treatment of patients and their partners has been the mainstay of gonorrhea control and prevention; thus, gonococcal antimicrobial resistance poses a grave challenge.

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