Gonorrhea May Become Incurable, Experts Fear

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Academic Journal
Main Category: Sexual Health / STDs
Also Included In: Public Health
Article Date: 10 Jan 2013 - 0:00 PST


A new strand of the sexually transmitted disease gonorrhea has been found to be antibiotic resistant, possibly rendering the disease incurable.

The strand was found in several North American patients, according to a new report in the Journal of the American Medical Association.

Researchers examined the effectiveness of cefixime, the only oral cephalosporin antimicrobial that is advised for treatment of gonorrhea infections. They found that this medicine had a failure rate of nearly seven percent for a group of patients treated in Toronto.

Background information in the study states:

"Because of Neisseria gonorrhoeae resistance to all prior first-line antimicrobial agents, cephalosporin [antibiotic] therapy with adjuvant azithromycin or doxycycline is recommended for treatment of gonorrhea. An increase in the minimum inhibitory concentration [MIC; lowest concentration of an anti-microbial agent that will prevent the growth of an organism] of N gonorrhoeae to cefixime, and to a lesser extent, an intramuscularly administered cephalosporin, ceftriaxone, has been identified in cultured isolates worldwide. The World Health Organization has sounded alarms for the threat of untreatable gonorrhea."

The alert issued by the World Health Organization was announced in June of 2012 and stated that there is an impending threat for an untreatable form of antibiotic resistant gonorrhea that could potentially initiate an epidemic.

The study was lead by Vanessa G. Allen, M.D.,M.P.H., of Public Health Ontario, Toronto, Canada and aimed to identify if certain strains of gonorrhea with increased resistance to cefixime are linked to clinical failures.

The study cohort included gonorrhea culture-positive participants diagnosed between May 2010 and April 2011 who were treated at a sexual health clinic in Toronto with cefixime as suggested by Public Health Agency of Canada guidelines.

The primary result measured was cefixime treatment failure, described as the repeat positive finding of gonorrhea before and after treatment, identified by identical molecular typing and clear denial of being subjected to gonorrhea again while being treated.

The investigators found that 6.7 percent of patients with gonorrhea still had the disease after their round of cefixime, which is the last antibiotic health professionals can use to successfully cure gonorrhea.

Out of the 133 participants who went back to the clinical for a test to see if their gonorrhea was cured, nine still tested positive for the disease, approximately one in fifteen people.

In a related editorial Robert D. Kirkcaldy, M.D., M.P.H., of the Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, and colleagues commented the following on failure of cephalosporin to treat gonorrhea:

"Its arrival is deeply troubling; clinicians now face the emergence of cephalosporin-resistant N gonorrhoeae without any well-studied, effective backup treatment options. New antibiotics for treating gonococcal infections are needed. A clinical trial sponsored by the National Institute of Allergy and Infectious Diseases examining novel combinations of existing drugs just completed enrollment, and a small study of a new oral agent is ongoing.

But the antibiotic pipeline is running dry: continued investment in antibiotic development is critical. Meanwhile, the gonococcus has continued to develop the capability to defeat each new antibiotic used. The threat of drug-resistant gonorrhea is increasing and has reached North America. Clinicians, drug developers, and public health professionals must act now."

In October of 2011 The Health Protection Agency, UK announced that gonorrhea was becoming more drug resistant. The study showed treatment failure with use of cefixime. The agency recommended a combination of ceftriaxone by inject with oral azithromycin.

Symptoms of gonorrhea in men include:

• Testicular swelling and/or pain
• Burning during urination
• Yellow, green, or white discharge from the penis

Symtoms of gonorrhea in women include:

• Spotting after intercourse
• Pain in the pelvic region
• Vulvitis (swelling of the vulva)
• Pain or burning during urination
• Yellow, green, or white vaginal discharge

Written by Kelly Fitzgerald
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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