Massachusetts finds alarming new strain of gonorrhea

Massachusetts finds alarming new strain of gonorrhea

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“We are approaching an era in which [patients] may no longer respond” to the drug, said Dr. Catherine Hsu, medical director of the Massachusetts Department of Public Health’s Division of STD Prevention and HIV/AIDS.

The discovery comes at a time when sexually transmitted infections, especially gonorrhea, are on the rise across the country and the ability of many germs to outsmart the drugs used to kill them is a growing concern.

“We have very few – very few – options. The concern is that we will get to a place where there are no options,” said Dr. Helen Boucher, chief academic officer of Tufts Medicine Health System and a member of the President’s Advisory Council on Antibiotic-Resistant Bacteria. “This is a common infection in young, healthy people. … There is only one thing, and it may no longer work.”

Dr. Ruan Barnabas, chief of infectious diseases at Massachusetts General Hospital, called the discovery of the strain “significant.”

“But given how mobile we are as a global community, it’s not surprising,” she said.

The news from Massachusetts should serve as a warning to doctors and patients to take gonorrhea seriously and watch for signs of resistance, said Dr. Laura Bachman, chief medical officer of the CDC’s Division of STD Prevention.

The Centers for Disease Control and Prevention and state health officials sent alerts to providers Thursday afternoon. The Massachusetts warning said the discovery is a warning that gonorrhea is “becoming less sensitive to a limited arsenal of antibiotics.”

“The message to suppliers is, ‘hey, we’ve got to keep an eye on this,'” Bachmann said. “Antimicrobial resistance is an important and urgent threat to public health.”

However, the CDC has not changed its recommendations for testing and treating gonorrhea. Bachmann called it “reassuring” that both Massachusetts patients were cured with a standard treatment, a single injection of ceftriaxone.

The strain is circulating in the Asia-Pacific region and 10 cases have recently been identified in the UK. Patients from the United Kingdom were also cured with ceftriaxone.

If ceftriaxone stops working, there are alternative drugs, but they carry greater risk or are less effective, doctors say.

“We want to keep the options we have,” Barnabas said.

She added that a potential vaccine is being developed.

Several new antibiotics that might work are also in the pipeline, but “economic realities” have slowed progress, with companies working on them going out of business, Boucher said.

Gonorrhea is a common and rapidly spreading sexually transmitted infection. Its incidence has increased by 45 percent from 2016 to 2020, and more than half of those infected are between the ages of 15 and 24. In Massachusetts, laboratory-confirmed cases of gonorrhea have quadrupled from a low of 1,976 cases in 2009 to 8,133 in 2021. The bacteria that cause it infect the linings of the reproductive tract and urethra in women and men, as well as the mouth, throat, eyes and rectum.

In many cases, infected people have no symptoms, which is why the CDC recommends screening tests for sexually active people. When symptoms do occur, they may include painful urination and urethral or vaginal discharge.

If left untreated, gonorrhea can lead to pelvic inflammatory disease and infertility in women and inflammation of the scrotum in men. Over time, it can spread to the blood and cause inflammation of the tendons, joints, brain or heart.

The Massachusetts cases were discovered as part of a routine testing process. A primary care physician performed a standard test to identify gonorrhea and also cultured the sample. After the culture identifies the infection as gonorrhea, an isolate of the organism is sent to the State Laboratory, which performs additional drug resistance testing.

The sample showed signs of resistance, so the state sent it to the CDC for more advanced testing, which identified a troubling genetic pattern: The bacteria were resistant to ciprofloxacin, penicillin and tetracycline, and had reduced susceptibility to ceftriaxone, cefixime and azithromycin.

This prompted the health department to ask clinical laboratories in the same region to send it additional samples from around the same time period. Additional testing at the CDC revealed the second case.

Health officials have not found a link between the two cases, and Barnabas said there are certainly more than two people infected with the new strain. But there is no information to indicate how widespread the new bug may be. A similar strain, which was not as resistant, was identified in Nevada in 2019, but was never seen again.

“We can’t be sure without increasing our surveillance efforts,” Hsu said, and now is “a major proactive moment for public health.”

It’s possible the strain is circulating elsewhere, Bachmann said. “That’s why it’s so important that providers have the radar and public health departments to watch for treatment failures.”

“To prevent resistance,” Bachmann said, “it’s really important that gonorrhea is identified quickly and treated appropriately with the right drug at the right time and the right amount. This requires providers to adhere to guidelines for screening and appropriate treatment.

The Massachusetts Department of Health requires providers to treat gonorrhea with high-dose ceftriaxone, perform cultures of symptomatic gonorrhea cases, and follow state laboratory specimen submission and testing protocols to ensure patients are cured after treatment. In addition, regular screening is recommended for sexually active women age 24 and younger, women at increased risk, and sexually active men who have sex with men.

As for what people can do, Public Health Commissioner Margret Cook offered the following advice in a statement: “We urge all sexually active people to get tested for sexually transmitted infections regularly and to consider reducing the number of sexual partners and increasing the use of condoms. when you have sex.”

Felice J. Freyer can be found at [email protected]. Follow her on Twitter @felicejfreyer.

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