Drug-Resistant Neisseria Gonorrhoeae Threat Level Urgent

DRUG-RESISTANT NEISSERIA GONORRHOEAE THREAT LEVEL URGENT

550,000 1.14M $133.4M Estimated Total new Annual discounted drug-resistant infections lifetime direct infections each each year medical costs year

Neisseria gonorrhoeae causes gonorrhea, a sexually transmitted disease (STD) that can result in life-threatening ectopic pregnancy and infertility, and can increase the risk of getting and giving HIV.

WHAT YOU NEED TO KNOW EMERGING ANTIBIOTIC RESISTANCE ■■ Gonorrhea has quickly developed resistance to all Gonorrhea rapidly develops resistance to antibiotics—ceftriaxone but one class of antibiotics, and half of all infections is the last recommended treatment. are resistant to at least one antibiotic. Tests to detect 35% 1980s: 2007: 2012: resistance are not available at time of treatment. Penicillin Ciprofloxacin Cefixime and tetracycline no longer no longer 30% no longer recommended recommended ■■ Gonorrhea spreads easily. Some men and most women recommended as a first-line regimen do not have symptoms and may not know they are 25% infected, increasing spread. 20% ■■ Untreated gonorrhea can cause serious and permanent

health problems in women and men, including ectopic 15% pregnancy and infertility, and can spread to the blood resulting in cardiovascular and neurological problems. 10% Resistance or Emerging Resistance or Emerging Resistance Percent of Gonococcal Infections with Infections of Gonococcal Percent 5%

0% 2000 2002 2004 2006 2008 2010 2012 2014 2016

Azithromycin Ciproﬂoxacin Ceﬁxime

Penicillin Ceftriaxone Tetracycline

STD Clinic

Private Provider

Emergency Room

Family Planning

Other Health Department Clinic

All Other

Unknown/ Missing Provider

0% 20% 40% 60% 80% 100% Percent of Patients 35% 1980s: 2007: 2012: Penicillin Ciprofloxacin Cefixime and tetracycline no longer no longer 30% no longer recommended recommended recommended as a first-line regimen 25%

20%

15%

10% Resistance or Emerging Resistance or Emerging Resistance

DRUG-RESISTANT NEISSERIA GONORRHOEAE with Infections of Gonococcal Percent 5%

0% CDC RESPONSE: STD TREATMENT2000 2002 2004 2006 ACROSS2008 2010 SETTINGS2012 2014 2016 DRUG-RESISTANT GONORRHEA Across all U.S. clinicalAzithromycin settings, dataCiproﬂoxacin suggest cliniciansCeﬁxime treated Penicillin Ceftriaxone Tetracycline Many people who have gonorrhea may not have most patients with CDC’s recommended gonorrhea treatment symptoms, so timely diagnosis through routine in 2017. screening, with prompt and effective treatment, is needed. CDC develops evidence-based STD Treatment STD Clinic Guidelines, which are the cornerstone of STD prevention and control. It is essential for healthcare providers Private Provider to follow the guidance to treat their patients with the correct antibiotic, which also slows the threat of Emergency Room emerging antibiotic resistance and helps to reduce gonorrhea in the United States. Family Planning

A recent CDC analysis found that healthcare providers Other Health treated most patients with gonorrhea (82%) in 2017 Department Clinic using CDC’s recommended regimen, just two years after All Other CDC published the updated guidelines in 2015. Through the efforts of CDC, partners, and healthcare providers, Unknown/ the uptake of gonorrhea guideline changes by providers Missing Provider was impressively swift. These data highlight the value of 0% 20% 40% 60% 80% 100% robust partnerships to ensure that patients receive the Percent of Patients highest quality STD care.

ONLINE RESOURCES About Gonorrhea www.cdc.gov/STD/Gonorrhea/Default.htm

Battling Antibiotic-resistant Gonorrhea: A Timeline of Coordinated Teamwork www.cdc.gov/STD/Products/Success/Hawaii-Success-Stories.pdf

This fact sheet is part of CDC’s 2019 Antibiotic Resistance Threats Report. The full report, including data sources, is available at www.cdc.gov/DrugResistance/Biggest-Threats.html. CS298822-A