A strain of gonorrhea that is resistant to all antibiotics was isolated by Japanese scientists in January. It hasn't gone far, but may spread very easily.
A new strain of gonorrhea (or "clap") has been isolated by Japanese scientists and has proven resistant to all antibiotics. Gonorrhea is one of the most common sexually transmitted diseases (STDs) in the world, with 700,000 new cases per year in the United States.
Gonorrhea in women can cause infertility, pelvic inflammatory disease, and chronic pain in the pelvis. In men, it can cause sterility, as well as painful scarring of the urethra (the tube from the bladder to the tip of the penis), urination problems and kidney failure. A mother can pass it to an unborn baby. It can lead to an ectopic pregnancy. In both sexes, it can lead to joint pain, heart valve infection, kidney failure and possibly death. It also increases the risk of transmitting and contracting HIV.
The disease was first treated in the 1940's with sulfonamides (sulfa drugs). Eventually, the bacteria became resistant to the drugs, so doctors switched to penicillin, which worked until the 1970's. Then, doctors turned to tetracycline, which eventually failed. Fluoroquinolones like Cipro came next and failed. Now, doctors use the cephalosporins, a class of antibiotics which, unfortunately, is the last remaining drug that effectively treats gonorrhea.
One of the problems with halting the progress of a new resistant strain is the fact that half of women who contract gonorrhea show no symptoms. 95% to 98% of men do have symptoms - burning on urination and pus discharge from the genitals. Gonorrhea can also infect the throat and the rectum, and symptoms can be missed. These infection sites are seen frequently in gay men. For a complete list of symptoms, go here.
The strain that the Japanese scientists discovered came from a sex worker. It was shown to be resistant to cepahalosporins, and further tests revealed that it could spread its resistance easily and quickly to other strains.
According to scientists in Japan and Sweden, who detected two cases in Norway, the new strain is "a true superbug that initiates a future era of untreatable gonorrhea," as quoted here According to the Centers for Disease Control and Prevention (CDC), physicians are advised to treat patients with the cephalosporins and a second antibiotic, azithromycin, because strains in the U.S. are gradually becoming more resistant. According to Dr. Robert Kirkcaldy, a medical epidemiologist at the CDC, quoted here said that "there is not a well-studied antibiotic we can turn to when cephalosporin resistance does emerge. That's why we are so concerned, and one reason we wanted to sound the alarm about these findings."
Dr. Peter Leone, professor of medicine at the University of North Carolina, Chapel Hill and chair-elect of the National Coalition of STD directors, was interviewed on National Public Radio, and foresees problems. He said that due to the economic crisis, many STD clinics have been shut down, and they are necessary to diagnose gonorrhea. Without the right screening, the disease could spread rapidly. He was concerned also about physicians who may not know the current treatment calls for the two medications, and that they may not have them available.
In the case of throat and rectal gonorrhea, symptoms may be missed. There are no FDA-approved tests, although there is one which is non-FDA-approved. However, there are many physicians that do not know how to order them and may not have them available, according to Dr. Leone. Half of women don't get screened and symptoms can be missed. You can be a carrier and not know it. He also said that gay men should go to a clinic and ask for the test, called a nucleic acid amplification test, which consists of swabs from the throat and rectum. He said it should be done every three months.
It is mandatory that the pharmaceutical industry study and develop new antibiotics. A program to motivate them financially should be considered by private and public bodies.
Written by Mark Riegel, MD
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