Experts Warn of Antibiotic-Resistant Gonorrhea

WEDNESDAY, Feb. 8 (HealthDay News) — Antibiotic-resistant
gonorrhea is an increasingly worrisome reality, and steps need to be taken
to limit the risk that an untreatable strain of the sexually transmitted
disease will spread, U.S. researchers warn.

“We’re trying to stay a step ahead by putting these warnings and alerts
out,” said Dr. Gail Bolan, of the U.S. Centers for Disease Control and
Prevention’s division of sexually transmitted diseases prevention.

Over 600,000 Americans contract gonorrhea every year, making it the
nation’s second-most common communicable disease. Minorities of all
types — whether in terms of race, ethnicity or sexual orientation — are
considered among the most vulnerable populations, according to background
information in the new report.

Drug-resistant gonorrhea isn’t a new phenomenon, Bolan and her
colleagues said. During World War II, gonorrhea became resistant to the
drug sulfanilamide. In the 1980s, resistance to the antibiotics penicillin
and tetracycline appeared. More recently, fluoroquinolone resistance was
observed in 2007.

The problem today, however, is that so-called third-generation
cephalosporins (including orally administered cefixime and the injectable
ceftriaxone) are the only remaining types of effective antibiotics
recommended by the CDC, when taken alongside one of two other oral
antibiotics (either azithromycin or doxycycline).

Writing in the Feb. 9 issue of the New England Journal of
Medicine
, the researchers warned that signs of resistance to even this
line of defense have been observed.

“The point now,” Bolan said, “is that we are down to the last class of
antibiotics that we know — that have been studied — to be effective in
the treatment of gonorrhea.” If a strain of resistant gonorrhea were to
take hold, “we have the potential of having no other antibiotics to turn
to,” she added.

Cephalosporin-resistant strains of the disease have been identified in
Japan (2003 and 2009) and the United Kingdom (2010). Such drugs remain
“highly effective” against most strains of gonorrhea seen in the United
States, the study authors noted.

Still, the investigators said that patient vigilance and coordinated
public health policies are needed if the United States is to stay a step
ahead of cephalosporin-resistant strains.

Prevention is always key, Bolan said, noting that gonorrhea is
preventable with the use of condoms.

But given that gonorrhea is often symptomless, “many patients who have
this infection don’t know they are infected. So for individuals, it’s very
important to go in for routine medicals,” she added.

“And certainly if you’ve got symptoms, we’re concerned that you . . .
get evaluated quickly,” she added. For women, symptoms can include vaginal
discharge, a burning sensation during urination and pain during
intercourse. For men, telltale signs include a clear penile discharge,
burning on urination and pain during defection.

While screening methods are effective, they don’t indicate resistance
to antibiotics. So, Bolan said, patients and doctors have to work together
to ensure that the recommended antibiotic treatment is doing the job,
while monitoring for any sign of treatment failure.

The sexual partners (going back two months) of those diagnosed should
also be treated. And because gonorrhea can be a potential sign of HIV
infection, the researchers urge repeated HIV testing for those diagnosed
with gonorrhea.

Commenting on the study, Dr. Thomas Quinn said that the specter of
rising antibiotic-resistant gonorrhea is worrisome.

“It’s a very common disease that is in the millions of cases if we’re
talking globally,” said Quinn, senior investigator in the International
HIV/STD section at the U.S. National Institute of Allergy and Infectious
Diseases.

“If untreated or unsuccessfully treated, it usually is not
life-threatening, but it does have severe complications in both sexes,” he
added. It’s particularly dangerous for women “because of the risk for
infertility.”

According to the CDC, each year roughly 24,000 American women become
infertile due to an untreated sexually transmitted infection.

“For men there can be extremely painful complications involving the
scrotum, although not fertility,” said Quinn, who is also a professor of
medicine at the Johns Hopkins School of Medicine in Baltimore.

“So this is a harbinger of bad times ahead unless we really take the
proper steps to address it,” he added. “We have a very common transmitted
organism that is once again rearing its head by increasing frequency in
the population and increasing resistance. And the public needs to know
about this.”

More information

For more on gonorrhea, visit the U.S. Centers for
Disease Control and Prevention
.

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