Super gonorrhea has infected known humans in the United States for the first time. This week, public health officials in Massachusetts announced the discovery of two gonorrhea cases that appear to show increased resistance to all known classes of antibiotics that can be used against it. Fortunately, these cases were still curable, but it’s the latest reminder that this common sexually transmitted disease is becoming a more serious threat.
Gonorrhea, caused by the bacteria of the same name Neisseria gonorrheais the second most commonly reported STI in the US, with 677,769 cases documented in 2020. Many infected people do not experience illness, but the first symptoms may include a discolored discharge from the genitals, painful or burning urination, and rectal bleeding if caught having anal sex. When gonorrhea is left untreated, it increases the risk of more serious complications, such as damage to the reproductive system in women and swollen testicles in men, both of which can lead to infertility. And when passed from mother to child, the infection can be fatal or cause blindness in newborns.
While gonorrhea was once easily treatable with a simple pill of penicillin or other antibiotics, the bacteria has learned steadily to withstand almost any drug that comes its way. Today, only one or two antibiotics taken at a time (depending on the region) are considered reliably effective against gonorrhea and are recommended as first-line treatments. But in recent years, doctors have seen cases of gonorrhea where it has begun to evade even these drugs. These very hardy or pan-resistant infections have so far been documented in parts of Europe and Asia, but at least two similar cases have now been identified in Massachusetts.
According to the state health department, the strain of gonorrhea isolated from one case clearly showed resistance or reduced response to five classes of antibiotics, while the strain drawn from the second case was genetically close enough to likely have similar resistance. A common genetic marker seen in these cases was previously identified in a case reported in Nevada, but that strain still responded normally to at least one class of antibiotics. To the best of health officials’ knowledge, these are the first documented cases of gonorrhea to show increased resistance to all drug classes known to treat it ever identified in the U.S.
“The discovery of this strain of gonorrhea is a serious public health concern that DPH, the CDC and other health departments have been vigilant about tracking down in the U.S.,” said Public Health Commissioner Margret Cooke in a statement. pronunciation of the agency.
Rising resistance rates to the antibiotic azithromycin led the US to stop recommending it for gonorrhea by the end of 2020. Now only the drug ceftriaxone – taken as an injection – is considered a first-line option in the country, and at a higher dose than before. Fortunately, despite the reduced response to ceftriaxone, both cases were successfully resolved after patients took these higher doses.
These cases are likely alone a warning of what is to come. Some of the important genetic markers seen in this new strain have been identified in pan-resistant cases from Europe and Asia, showing that these mutations continue to spread around the world. Gonorrhea rates in general have increased year after year in the U.S. And perhaps most disturbingly, no clear link has been found between the two cases in Massachusetts, suggesting that these strains may already be circulating past the point where they can be easily contained.
There are ongoing efforts to develop vaccines and new antibiotics against gonorrhea, but it could take years for any of these to come to fruition, if any. So it has only become more important to take precautions against contracting and spreading these STIs. Health officials are now alarm doctors and testing labs in Massachusetts to find and report similar cases.
“We urge all sexually active people to get tested regularly for sexually transmitted diseases and to consider reducing the number of sexual partners and using more condoms during sex. Physicians are advised to review the clinical alert and assist in our expanded surveillance efforts,” Cooke said.