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Health Alert: Treatment for Fluoroquinolone-resistant (QRNG) Gonorrhea

May 2007

The CDC has announced that fluoroquinolones are no longer recommended for the treatment of gonorrhea in the United States. This recommendation was based on analysis of new data from CDC’s Gonococcal Isolate Surveillance Project (GISP).

Recommended options for treating gonorrhea are now limited to a single class of antibiotics, cephalosporins. Within this class, the NYSDOH and CDC recommend ceftriaxone, available only as an injection, as the preferred treatment for all types of gonorrhea infection (genital, anal, and pharyngeal).

Because of the lack of treatment options, CDC strongly encourages state and local health departments to:

  • Maintain or develop capacity to culture for N. gonorrhoeae
  • Maintain capacity or develop partnerships with other experienced laboratories to conduct drug susceptibility tests for any patients who fail gonorrhea treatment

NYSDOH BSTDC recommends that all patients treated for gonorrhea infection (including those treated with cephalosporins) must have a follow-up physical examination (anogenital and oral) and a test of cure (TOC) from the infected sites identified at the time of the initial diagnosis. A TOC is essential in all cases, even those asymptomatic after treatment. Isolates from treatment failures should be tested for antibiotic resistance.

  • TOC is recommended at 2 weeks post-treatment if using culture or at 4 weeks post-treatment if using nucleic acid amplification tests (NAAT) regardless of whether symptoms have resolved or not.
  • If the post-treatment NAAT is positive, a culture must be performed to assess for resistance.

Providers should report all cases or suspected cases of resistance to state and local public health authorities so that the NYSDOH and CDC can closely monitor and appropriately respond to any emerging resistance.

The complete alert from the NYSDOH Bureau of Sexually Transmitted Disease Control can be accessed by clicking here.