Preventing Antibiotic-Resistant Gonorrhea by Changing Treatment Guidelines and Educating Health Care Providers

What to know

Gonorrhea, a common STD, can be treated with medicine but may become resistant to the medicine over time. By preventing antibiotic resistance, CDC can prevent more gonorrhea cases from spreading or becoming harder to treat.

A doctor gestures while providing a medical consultation to a patient.

Gonorrhea overview

People who are sexually active can get gonorrhea, a common sexually transmitted disease (STD). It usually causes infection in the genitals, rectum, or throat. However, it also can spread to the bloodstream, heart, and nervous system.

A pregnant person with gonorrhea can give the infection to their baby during delivery. This can cause serious health problems, including blindness, for the baby.

In 2019, a total of 616,392 cases of gonorrhea in the United States were reported to CDC. This is a rate of 188.4 gonorrhea cases per 100,000 persons. Moreover, the rate of gonorrhea cases has increased 92% since 2009.1

Without treatment, gonorrhea can cause serious and permanent health problems, including infertility in women.

CDC treatment guideline updates and antibiotic resistance

Gonorrhea can be treated with medicine, but the bacteria can develop resistance to antibiotics over time. The term antibiotic resistance means that medicines that have been used to treat an infection may no longer work.

CDC's Gonococcal Isolate Surveillance Project monitors gonorrhea's bacterium, Neisseria gonorrhoeae, and how susceptible it is to antibiotics. When CDC learns that gonorrhea has developed resistance to an antibiotic regimen that was working, it will update its recommendations for health care providers.

CDC has updated its gonorrhea treatment recommendations multiple times since 2000 due to increasing resistance. The most recent update was in 2021 (for more information, see STI Treatment Guidelines, 2021).

Antibiotic resistance can make treating gonorrhea and preventing its spread much more difficult. By preventing antibiotic resistance, CDC can prevent gonorrhea cases. This limits additional medical complications and saves on the cost of health care.

For example, increasing cephalosporin resistance could lead to:

  • 1 million additional gonococcal infections
  • 600 additional gonorrhea-attributable human immunodeficiency virus (HIV) infections
  • Cost approximately $400 million over 10 years2

Educating health care providers and changing treatment practices

To prevent antibiotic-resistance gonorrhea, health care providers should update their treatment practices to be consistent with CDC's current STI Treatment Guidelines, 2021). Previous evaluations show that health care providers are aware of when CDC publishes new STD treatment guidelines and update their practices as needed.34567

For example, 2015 STD Treatment Guidelines recommended ceftriaxone 250 mg plus azithromycin 1 g to treat uncomplicated gonorrhea. In 2016, a review of U.S. surveillance data showed 81% of reported gonorrhea cases were treated with this regimen. The highest rates of clinics following this regimen included:

  • STD clinics (91%)
  • Family planning or reproductive health clinics (94%)

In 2021, the STD Treatment Guidelines updated recommendations. The new guideline recommends only a higher ceftriaxone dose of 500 mg for a person weighing less than 150 kg as the recommended regimen for uncomplicated gonorrhea.

Data are not yet available for adherence to the 2021 guidelines, which were released in July 2021.

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Content Source:
National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention
  1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2019. Atlanta: U.S. Department of Health and Human Services; 2021
  2. Chesson HW, Kirkcaldy RD, Gift TL, Owusu-Edusei K Jr, Weinstock HS. An Illustration of the Potential Health and Economic Benefits of Combating Antibiotic-Resistant Gonorrhea. Sex Transm Dis. 2018;45(4):250-253. doi:10.1097/OLQ.0000000000000725
  3. Weston EJ, Workowski K, Torrone E, Weinstock H, Stenger MR. Adherence to CDC Recommendations for the Treatment of Uncomplicated Gonorrhea — STD Surveillance Network, United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:473–476. DOI: http://dx.doi.org/10.15585/mmwr.mm6716a4external icon.
  4. Kerani RP, Stenger MR, Weinstock H, et al. Gonorrhea treatment practices in the STD Surveillance Network, 2010-2012. Sex Transm Dis 2015;42:6–12.
  5. Dowell D, Tian LH, Stover JA, et al. Changes in fluoroquinolone use for gonorrhea following publication of revised treatment guidelines. Am J Public Health 2012;102:148–55.
  6. Lechtenberg RJ, Samuel MC, Bernstein KT, Lahiff M, Olson N, Bauer HM. Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011. Sex Transm Dis 2014;41:338–44.
  7. Swails J, Smock L, Hsu K. Provider characteristics associated with guideline-nonadherent gonorrhea treatment, Massachusetts, 2010. Sex Transm Dis 2014;41:133–6