Public health officials said they discovered two cases of gonorrhea that appear to have reduced susceptibility to all types of antibiotics available to treat them. This is the first time such antibiotic-resistant strains of gonorrhea have been identified in the United States.
The increase in sexual activity during the pandemic, coupled with a decrease in the number of people undergoing routine health examinations, has accentuated the spread of sexually transmitted infections around the world.
These infections, including gonorrhea, are becoming increasingly resistant to the antibiotics available to treat them, a problem that is becoming a serious public health threat.
Globally, antibiotic-resistant infections kill around 700,000 people each year. This number is expected to rise to 10 million deaths per year by 2050 if steps are not taken to stop the spread of resistant organisms.
Experts say it was never a question of when this highly resistant strain of gonorrhea would reach the United States, but when.
“The problem is that this particular strain has been circulating around the world, so it was only a matter of time before it reached the United States,” says Dr. Jeffrey Klausner, clinical professor of public health. at the University of Southern California. Keck Los Angeles School of Medicine.
“It’s a reminder that gonorrhea is becoming more and more resistant, more and more difficult to treat. We don’t have any new antibiotics. We haven’t had new antibiotics to treat gonorrhea in years and we really need a different treatment strategy,” said Klausner, who sits on the CDC’s Gonorrhea Treatment Task Force.
Gonorrhea is sexually transmitted and one of the most commonly diagnosed infections in the United States. It is caused by bacteria Niesseria gonorrhoeae, which can infect the mucous membranes of the genitals, rectum, throat and eyes.
People can be infected without showing symptoms. Untreated, the infection can cause pelvic pain and infertility in women and blindness in newborn babies.
In addition to reduced susceptibility to ceftriaxone, gonorrhea strains identified in Massachusetts also showed reduced susceptibility to cefixime and azithromycin; the strains were resistant to ciprofloxacin, penicillin and tetracycline, according to a clinical alert sent to doctors by the Massachusetts Department of Public Health.
The MDPH says it has not yet found any link between the two cases.
In 2021, the United States Centers for Disease Control and Prevention recommended giving a double dose of the antibiotic ceftriaxone in an effort to overcome the bacteria’s resistance to this antibiotic, and it seems to have worked in these cases, but this antibiotic is the last line of defense against this infection, and experts say a new approach is needed.
Klausner hopes to gain FDA approval for a test that would tailor antibiotic treatment to the genetic susceptibilities of the particular strain of gonorrhea that infects a person. It’s called resistance-guided treatment, and Klausner says it works for HIV, tuberculosis and some other hospital-acquired infections, but it’s never really been tried for gonorrhea.
This strain of gonorrhea has previously been seen in Asia-Pacific countries and the UK, but not in the US. A genetic marker common to these two Massachusetts residents was also observed in a Nevada case, although this strain retained susceptibility to at least one class of antibiotics.
The first symptoms of gonorrhea are often painful urination, abdominal or pelvic pain, increased vaginal discharge or bleeding between periods, but many infections are asymptomatic, according to the CDC, which makes routine screenings important for catch the infection.
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