Last week, the Massachusetts Department of Public Health announced the first cases of a concerning new gonorrhea strain. The new strain shows reduced response to multiple antibiotics and another case was also found that had genetic markers that indicate a similar drug response. The clinical alert from the Massachusetts Department of Public Health can be found here.

Both cases in Massachusetts were successfully cured with ceftriaxone, the antibiotic recommended to treat gonorrhea currently. This strain of gonorrhea has been previously seen in Asia-Pacific countries and in the United Kingdom but not in the United States. To date, there has been no direct connections between the two individuals identified in the Massachusetts. The genetic marker common in these two residents has been seen in a previous case in Nevada, but that strain retained sensitivity to at least one class of antibiotics.

The Massachusetts cases were detected by DPH’s State Public Health Laboratory as part of disease surveillance activities. Field epidemiologists in DPH’s Division of Sexually Transmitted Disease Prevention are conducting contact tracing to determine if other individuals have acquired this infection. Overall, these cases are an important reminder that strains of gonorrhea in the US are becoming less responsive to a limited arsenal of antibiotics.

CDC is circulating a Dear Colleague Letter on the topic which can be found here and below are reminders on specific actions to take if there is suspicion of a gonococcal treatment failure in any patient at any anatomic site: 

• Conduct a thorough sexual history to evaluate for possible reinfection. 
• If reinfection has been ruled out, repeat NAAT testing at all exposed anatomic sites, along with collection of specimens for gonococcal culture and antimicrobial susceptibility testing (AST). Clinics that do not have access to culture and AST can reach out to two regional laboratories. 
• Treating clinicians should consult a STD Clinical Prevention Training Center clinical expert or CDC for advice on obtaining cultures, antimicrobial susceptibility testing, and treatment. 
• Presumptive treatment failures, where re-infection has been ruled out, should be reported to CDC through the local or state health department within 24 hours of diagnosis.