Resistant GC in MSM

Annals with article on antimicromial resistance of GC, comparing men who have sex with men MSM vs men who have sex exclusively with women MSW (see GC in msm resistance annals 2013 in dropbox).  CDC sponsored surveillance study of 35K men with symptomatic GC over 6 year period. From 30 STD clinics throughout US.

 

--in all US regions except West, MSM signif more likely to have GC resistant to ceftriax and azithro (elevated MICs, which suggest emerging resistance) than MSW. Also high prevalence of actual                                             resistance to cipro, penicillin and tetracycline.  For our region (Northeast and South):

 

-- Emerging resistance (expressed as odds ratio comparing MSM vs MSW):

        azithro 3.7

        cefixime 33.1

        ceftriax 3.6

        multidrug 36.4

--endemic resistance

        cipro 2.5

        penicillins 2.3

        tetracycline 2.1

 

So, pretty bad news.  Clear that cefixime is pretty useless....  Major points are

        --important to assess MSM vs MSW, with more aggressive followup for MSM to make sure cured

        --the obvious key point is that there needs to be much more aggressive prevention strategies

        --and, per usual, more effective drugs (though, as a side issue, drug companies are devoting a much decreased effort in antimicrobial development, since the profit margin of a 7-10 day course of meds pales compared to chronic meds -- diabetes, cancer, etc)