Ceftriaxone now preferred for gonorrhea in MSM.(News)(sex with men)

Fluoroquinolones should no longer be used to treat Neisseria gonorrhea in men who have sex with men, according to the Centers for Disease Control and Prevention.

The new recommendation comes after preliminary data showed that drug resistant gonorrhea cases significantly increased in the United States in 2003, particularly in that population, said Dr. John Douglas, director of the CDC's STD prevention programs, at a press briefing.

The CDC now recommends that men who have sex with men (MSM) be treated with either ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally (not currently available in the United States): Spectinomycin 2 g intramuscularly is an alternative (MMWR 53[16]:335-38, 2004).

The recommendation of an intramuscular injection as first line therapy creates a "clinical hassle," noted Dr. Karla Schmitt, chief, Bureau of Sexually Transmitted Diseases Prevention and Control at the Florida Department of Health, Tallahassee. "Gonorrhea is mostly treated in the office setting, and offices try to minimize injections for safety reasons." with injections, there are also matters of staffing and related costs as well as acceptance from patients, she added.

Dr. Schmitt noted that the oral agent cefixime will eventually be available in the United States, which is "encouraging." Lupin Pharmaceuticals Inc. of Baltimore received Food and Drug Administration approval to manufacture and market cefixime in February 2004.

But ceftriaxone is the only truly viable treatment at this moment, she said. "Spectinomycin is very difficult to obtain and is not produced in large quantities right now," Dr. Schmitt said.

If spectinomycin is obtained and used, the drug may only be used for urogenital and anorectal gonorrhea; it is not sufficiently effective to treat pharyngeal gonorrhea, according to the CDC.