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STD: Antibiotic-Resistant Gonorrhea

What is antibiotic-resistant gonorrhea?

Antibiotic-resistance, or antimicrobial resistance, happens when germs like bacteria develop the ability to resist, and even defeat, the drugs designed to kill them. That means the bacteria are not killed and continue to grow, and the person infected may stay sick or get sicker.

From the 1930s to today, Neisseria gonorrhoeae, the bacteria that cause gonorrhea infections, have grown resistant to nearly every drug used to treat gonorrhea. These instances are referred to as antibiotic-resistant gonorrhea

Today, the U.S. has just one recommended gonorrhea treatment option remaining: ceftriaxone. The CDC (Centers for Disease Control and Prevention) treatment guidelines (PDF) recommend:

  • A single intramuscular 500mg dose of ceftriaxone for people who weigh less than 331 lbs;(150 kg).
  • A single intramuscular 1000mg dose of ceftriaxone for people who weigh 331 lbs (150 kg) or more.

People with allergies to cephalosporins may be treated with a CDC-approved alternative regimen.

Providers and case investigators should assess for suspected treatment failure (STF) among their patients and use tests of cure (TOCs) to assess for persistent cases that may be resistant to treatment.

How to identify antibiotic-resistant gonorrhea

Look out for suspected treatment failure

Health professionals and local and tribal health departments are advised to look out for instances of suspected treatment failure among patients treated for uncomplicated gonorrhea. Suspected treatment failure refers to cases of gonorrhea that don’t go away despite treatment with the recommended antibiotic regimen. STF should be assessed for patients whose symptoms do not resolve within three or more days after the recommended treatment and either:

  • Report no sexual contact during the post-treatment follow-up period, or
  • Have a positive culture on TOCs regardless of sexual activity.

Learn how to identify suspected treatment failure

Do a test of cure to be sure the infection was treated successfully

A test of cure (TOC) is follow-up testing to be sure the infection was treated successfully. This should be performed for any patients with gonorrhea isolates with reduced susceptibility, patients exhibiting signs of STF, patients with anogenital gonorrhea not treated with the recommended CDC regimen or CDC-recommended alternative regimens, and any patient with pharyngeal gonorrhea. Contact the DHS Sexually Transmitted Infections (STI) Unit SURRG Project epidemiology coordinator at DHSDPHARGC@dhs.wisconsin.gov if you need help with or have questions about tests of cure.

Learn more about how and when to do a TOC

Order an antibiotic susceptibility test to see if the bacteria have resistance to recommended antibiotics

Antibiotic susceptibility testing is done to confirm if a patient has a type of gonorrhea that has reduced susceptibility or resistance to treatment with recommended antibiotics. A patient's sample is put on a petri dish that also contains different antibiotics used to kill the bacteria. If bacteria are able to be grown on the plate even with certain antibiotics present, that is a sign of reduced susceptibility or resistance to antibiotics. Doctors should then prescribe an alternative antibiotic regimen. See the full CDC STI Treatment Guidelines (PDF) for more information.

What is Wisconsin Department of Health Services (DHS) doing?

Collaborating through SURRG

The Strengthening the United States Response to Resistant Gonorrhea (SURRG) Project began in 2016 as one of the national strategies to combat the threat of antibiotic-resistant gonorrhea. DHS and the Milwaukee Health Department and Laboratory (MHD and MHDL) collaborate to pilot and identify best practices for responding to cases of antibiotic-resistant gonorrhea.

Three coworkers collaborate in an office.

This work supports three core national goals:

  • Enhance domestic gonorrhea surveillance and infrastructure
  • Build capacity for rapid detection and response to antibiotic-resistant gonorrhea through increased culturing and local antibiotic susceptibility testing
  • Rapid field investigation to stop the spread of resistant infections

Collaboration with and effort by clinical, laboratory, and data staff is crucial to advance these goals and address antibiotic-resistant gonorrhea.

Expanding capacity for antibiotic-resistant gonorrhea testing

Each state participating in SURRG has worked to implement a Center of Excellence (COE) within their home state. COEs serve as hubs for enhanced antibiotic-resistant gonorrhea testing services and the identification of best practices for antibiotic-resistant gonorrhea diagnostics. The Milwaukee Health Department Laboratory is the statewide COE for Wisconsin. This means DHS and CDC funds them to assist health care providers and public health practitioners to access antibiotic-resistant gonorrhea testing at no cost.

Hand holding a petri dish

Health care providers or public health providers across Wisconsin can access no-cost diagnostic services for antibiotic-resistant gonorrhea, including:

  • Culture of samples.
  • TOC.
  • Antibiotic susceptibility testing.
  • Consultation for alternative treatment decisions.

If you or your clinic would like to request these services or have questions, contact the DHS Sexually Transmitted Infections (STI) Unit SURRG Project epidemiology coordinator at DHSDPHARGC@dhs.wisconsin.gov.

Resources for health professionals and local and Tribal health departments in Wisconsin

Last revised April 11, 2024