“We are approaching a time when [patients] may no longer respond” to the drug, said Dr. Katherine Hsu, medical director for the Division of STD and HIV/AIDS Prevention at the Massachusetts Department of Public Health.
The discovery comes as sexually transmitted infections, particularly gonorrhea, are skyrocketing across the country, and the ability of many microbes to thwart the drugs used to kill them is a growing concern.
“We are reduced to very few – very few – options. The concern is that we will get to a place where there are no options,” said Dr. Helen Boucher, director of health system studies at Tufts Medicine and a member of the Presidential Advisory Council on Combating Bacteria. resistant to antibiotics. “This is a common infection in healthy young people. … There’s only one thing, and that thing may not work anymore.
Dr Ruanne Barnabas, chief of the division of infectious diseases at Massachusetts General Hospital, called the strain’s discovery “significant”.
“But given how mobile we are as a global community, it’s not surprising,” she said.
The Massachusetts news should serve as a warning to doctors and patients to take gonorrhea seriously and watch for signs of resistance, said Dr. Laura Bachmann, chief medical officer of the CDC’s Division of STD Prevention. .
The Centers for Disease Control and Prevention and state health officials both sent out alerts to providers Thursday afternoon. The Massachusetts alert said the finding is a warning that gonorrhea is “becoming less susceptible to a limited arsenal of antibiotics.”
“The message to suppliers is, ‘hey, we have to keep an eye on this,'” Bachmann said. “Antimicrobial resistance is a significant and urgent threat to public health.”
Still, the CDC hasn’t changed its recommendations for gonorrhea testing and treatment. Bachmann called it “reassuring” that the two Massachusetts patients were cured with 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. British patients have also been cured with ceftriaxone.
If ceftriaxone stops working, there are alternative medications, but they have greater risks 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.
A few new antibiotics that might work are also in the works, but “economic realities” have slowed progress, with companies working on them going bankrupt, Boucher said.
Gonorrhea is a common and fast-spreading sexually transmitted infection. Its incidence has increased by 45% from 2016 to 2020, and more than half of those infected are between 15 and 24 years old. In Massachusetts, laboratory-confirmed cases of gonorrhea quadrupled from 1,976 cases in 2009 to 8,133 in 2021. The bacteria that cause it infect the mucous membranes of the reproductive tract and urethra in women and men, as well as the mouth, throat, eyes and rectum.
In many cases, infected people show no symptoms, which is why the CDC recommends testing for sexually active people. When symptoms 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 through the blood and cause inflammation of 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 identified the infection as gonorrhea, an isolate of the organism was sent to the state laboratory, which performed further drug resistance testing.
The sample showed signs of resistance, so the state sent it to the CDC for further testing, which identified the concerning 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 labs in the same area to send it additional samples around the same time. Further testing at the CDC revealed the second case.
Health officials found no link between the two cases, and Barnabas said there were likely 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 that wasn’t as resistant was identified in Nevada in 2019 but was never seen again.
“We can’t be sure without stepping up our surveillance efforts,” Hsu said, and now is “a crucial proactive time for public health.”
It’s possible the strain is circulating elsewhere, Bachmann said. “That’s why it’s so important for providers to have it on their radar and for public health departments to keep tabs on treatment failures.”
“To prevent resistance,” Bachmann said, “it’s really important to identify gonorrhea early and treat it appropriately with the right drug at the right time and in the right amount. This requires providers to be in tune with testing guidelines and appropriate treatment.
The Massachusetts Department of Health requires providers to treat gonorrhea with high doses of ceftriaxone, perform cultures from symptomatic gonorrhea cases and follow protocols for submitting specimens to the state laboratory, and testing to ensure that patients are cured after treatment. Additionally, regular screening is recommended for sexually active women aged 24 and under, women at increased risk, and sexually active men who have sex with men.
As for what individuals can do, Public Health Commissioner Margret Cooke gave this advice in a statement: “We urge all sexually active people to be tested regularly for sexually transmitted infections and to consider reduce the number of their sexual partners and increase their use of condoms. during sexual intercourse.
Felice J. Freyer can be contacted at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.
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