Massachusetts health authorities announced Thursday that they have identified two cases of a new strain of gonorrhea that appears to have developed resistance to a wide variety of antibiotic treatments.
Both patients got better after receiving injections of ceftriaxone, the main drug currently recommended to treat cases of sexually transmitted infection. But state health officials warn that the strain that infected them is showing signs of at least some resistance to almost every drug to treat the bacteria, the first of its kind confirmed in the US to date.
Researchers are now working with the Centers for Disease Control and Prevention to test other samples collected from gonorrhea cases in the state. Massachusetts is also conducting contact tracing to find out if the drug-resistant strain has spread to others.
“The discovery of this form of gonorrhea is a serious public health problem that DPH, the CDC and other health departments have been vigilant about,” Margret Cooke, chief of the Massachusetts Department of Public Health, said in a statement Thursday.
According to the CDC, gonorrhea is the second most common sexually transmitted disease reported to health authorities in the US, after chlamydia.
Many infected by the bacteria often have little to no symptoms. However, some may experience bleeding, discharge and more serious complications that can lead to infertility and pain.
The first case was identified in a patient who went to a primary care clinic with symptoms of urethritis, a type of irritation that can make urinating difficult. Samples examined by the state’s health lab highlighted a “disturbing” pattern that was later verified by follow-up testing by the CDC.
A state spokesperson declined to clarify additional details about the two cases beyond those listed in the department’s announcement and alert to providers.
No direct link has been found between the two cases. One had no recent travel history, suggesting tension could spread within the state.
“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,” said Cooke.
Gonorrhea’s “alarming” drug resistance
For years, health authorities have been working to respond to gonorrhea’s “alarming” ability to develop resistance to antibiotics that have been deployed.
In 2013, the CDC listed gonorrhea as one of the three most pressing threats from antibiotic-resistant bacteria. Both US and world health authorities have launched campaigns to curb new cases of gonorrhea in hopes of controlling the bacteria until vaccines and new treatments are developed.
The Massachusetts cases are the first confirmed lab cases that have developed the ability to bypass six of the seven drugs that health authorities track for possible resistance. It involves a change in the “penA60 allele” – a gene mutation – that has been linked to previous ceftriaxone-resistant cases in Nevada, the United Kingdom and Asia.
“This case is a reminder that antimicrobial-resistant gonorrhea remains an urgent public health threat nationally and internationally; all healthcare providers in all clinical settings must remain vigilant,” Dr. Laura Hinkle Bachmann, chief medical officer of the CDC Division of STD Prevention, said in a letter to providers Thursday.
Ceftriaxone injections, boosted with other oral antibiotics such as azithromycin and doxycycline, have been the last recommended treatment for gonorrhea since 2012. At the time, lab data showed that a related drug known as cefixime was losing effectiveness and also threatened to create resistance to ceftriaxone.
Only one drug tested against the Massachusetts strain by the CDC panel — gentamicin — showed no sign of reduced susceptibility. However, that drug is already widely considered a less effective treatment for gonorrhea.
Scientists have been pursuing new drugs for gonorrhea like zoliflodacin, which showed promising early results in a 2018 study supported by the National Institutes of Health. That drug is currently being studied in clinical trials and is not approved by the Food and Drug Administration for gonorrhea.
“Timely identification and treatment, as well as a rapid public health response, are essential to keeping patients safe and reducing the risk of community transmission. We must all remain alert to potential gonococcal treatment failures as we address the growing threat of antimicrobial combat resistance,” Bachmann said.