Gonorrhea becomes rampant; highly resistant cases found in the USA

Gonorrhea becomes rampant; highly resistant cases found in the USA

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Color scanning electron micrograph of Neisseria gonorrhoeae bacteria, which causes gonorrhea.

The most drug-resistant cases of gonorrhea found in the U.S. to date occurred in two unrelated people in Massachusetts. state health officials said Thursday.

The cases mark the first time the US has isolated the bacterium that causes gonorrhea, Neisseria gonorrhoeaehave shown complete resistance or reduced sensitivity to all drugs recommended for treatment.

Fortunately, both cases were successfully treated with powerful injections of the antibiotic ceftriaxone, although the bacterial isolates demonstrated reduced susceptibility to the drug. Ceftriaxone is currently the first recommended treatment for sexually transmitted infections.

But health officials said the cases were a warning. “N. gonorrhoeae is becoming less sensitive to a limited arsenal of antibiotics,” they said.

Boiling resistance

for years, global monitoring data collected by the World Health Organization showed that gonorrhea is becoming increasingly resistant to our entire range of drugs, including first-line drugs such as ceftriaxone. Although observation is globally uncertain, WHO data survey 2017–2018 published in 2021 found N. gonorrhoeae isolates with reduced susceptibility or resistance to ceftriaxone were found in 21 of the 68 reporting countries, or 31 percent.

Resistance to alternative antibiotics is even higher. Among 61 countries reporting data on an alternative antibiotic, azithromycin, 51 countries (84 percent) reported resistance. And of the 51 countries reporting data on the alternative antibiotic treatment, cefixime, 24 countries (47 percent) reported resistance. For ciprofloxacin, an antibiotic that has been largely abandoned as a treatment for gonorrhea due to resistance, all 70 reporting countries found resistance.

“In many countries, resistance to ciprofloxacin is extremely high, resistance to azithromycin is rapidly increasing, and resistance or reduced susceptibility to ceftriaxone and cefixime continues to emerge,” the WHO said in 2021. “Without new treatment for gonorrhea, there will be people with infections with gonorrhea which will be difficult to treat and cure.”

The agency was not exaggerating. Last year, the WHO added that the reports of failed gonorrhea treatment accumulate. “Over the past decade, confirmed treatment failures for gonorrhea with ceftriaxone alone or in combination with azithromycin or doxycillin have been reported in Australia, France, Japan, Slovenia, Sweden and the United Kingdom of Great Britain and Northern Ireland,” the WHO said.

One of the isolates reported in Massachusetts yesterday demonstrated reduced susceptibility to ceftriaxone, cefixime and azithromycin and resistance to ciprofloxacin, penicillin and tetracycline in laboratory tests. The second isolate appears to have a similar profile based on genetic data, the Massachusetts Department of Public Health said. This strain of N. gonorrhoeae has been seen circulating in Asia-Pacific countries and has been detected in recent cases in the United Kingdom.

High cases

Alongside the alarming trend of increased resistance is the fact that gonorrhea cases are high worldwide and rising in the US. In 2020, the WHO estimated that there were 82.4 million new cases of gonorrhea worldwide. In the US, there were nearly 700,000 upward cases in 2021 more than 25 percent since 2017according to preliminary estimates from the Centers for Disease Control and Prevention.

Many people have no symptoms of gonorrhea. In others, it is so mild that it can be mistaken for a mild bladder infection or yeast infection. Over time, however, it can lead to pelvic inflammatory disease, severe pain, and fertility problems. Health officials stress the need for screening and monitoring to treat infections early, before they become severe and have a chance to spread.

For the two cases in Massachusetts, health officials are already working on contact tracing. With no clear link between the two cases, officials say it’s likely more widespread than currently known.

“The discovery of this strain of gonorrhea is a serious public health concern that DPH, CDC and other health departments have been vigilant about discovering across the U.S.,” Massachusetts Public Health Commissioner Margret Cook said in a statement. “We urge all sexually active people to get tested regularly for sexually transmitted infections and to consider reducing the number of sexual partners they have and increasing the use of condoms when having sex. Clinicians are advised to review the clinical alert and assist with our expanded surveillance efforts.”

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