In recent years, there have been increasing reports that gonorrhea has increased again. Here in Germany, most of them are left cold because Germany is not mentioned in the statistics on the increase in the incidence rate.
There is no obligation to report gonorrhea anymore
This is not because safer sex is practiced here, but because in 2001, the obligation to register was abolished in Germany. Only in Saxony is there a reporting obligation for laboratories. A doubling of reported gonococcal infections from 6.8 infections / 100,000 population in 2003 to 13.7 / 100,000 in 2011 was reported here.
Current drug for resistance: changing the class of antibiotics
It does not necessarily alarm you. Gonorrhea was an almost trivial infection cured with antibiotics. Even reports of the development of resistance in practice have only meant that another antibiotic is now being used – in recent decades, the antibiotic class of penicillin has changed during tetracycline compared to today's standard azithromycin.
Increases resistance to Neisseria gonorrhoeae
But now the problem is getting worse: gonorrhea infections are increasingly reported with multiple resistant pathogens. This now also applies here to Germany Azithromycin. The Robert Koch Institute (RKI) reports another case of infection with a highly resistant pathogen: the azithromycin-resistant Neisseria gonorrhoeae strain (HL-AziR-NG). As RKI further reports, determination of antibiotic susceptibility by gradient diffusion assay showed HL-AziR-NG (MIC> 256 mg / L), resistance to tetracyclines (1.5 mg / L) and intermediate sensitivity to penicillin (MIC = 0 , 38 mg / L) without detecting beta-lactamase production. Sensitive tests on cefixime (MIC = 0.016 mg / L), ceftriaxone (MIC = 0.004 mg / L) and ciprofloxacin (MIC = 0.008 mg / L) were sensitive.
Combination therapy still helps
Guideline-based dual therapy for gonorrhea currently consists of a combination of ceftriaxone of 1 g v. And azithromycin 1.5 g per os, each as a single dose.
Azithromycin is unsuitable for monotherapy because of the described development of resistance. Third-generation cephalosporins, especially ceftriaxone and with limited cefixime, are the last remaining effective treatment options – but resistance is also becoming increasingly common here.
Another problem: Cefixim currently has a bottleneck in delivery that will continue in the coming months through the end of 2019.
Tripper: Always antibiogram, always therapy control
According to RKI, antibiotic susceptibility testing is essential in diagnosing gonorrhea to determine existing resistance. The success of therapy should also necessarily be monitored.
The emergence of this high-level resistance is a global problem. For example, since the fall of 2014, a continuous outbreak of more than 100 cases of gonorrhea with HL-AziR pathogens has been reported in the UK. And these cases do not affect certain at-risk groups such as gay men, as might be expected, but heterosexual men and women. Here, too, in Germany, the high incidence of gonorrhea suggests that multiple resistant strains of gonococci are more common.
Report resistance to RKI
The emergence of such a dangerous situation of resistance requires strong vigilance for regional and global development. Cases of unusual resistance and treatment failure should be reported to RKI immediately.