Incidence of gonorrhea, caused by the bacterium Neisseria gonorrhoeae, has risen sharply in recent years, the CDC said. PHOTO: JOE MILLER/CDC/GETTY IMAGES By Dominique Mosbergen Follow Jan. 29, 2023 8:00 am ETPRINTTEXT
A highly drug-resistant strain of gonorrhea has been detected in the U.S. for the first time, raising concerns among public-health officials about the scarcity of treatments and a future when gonorrhea could become untreatable.
The Massachusetts Department of Public Health said on Jan. 19 that it had detected two cases of a novel strain of gonorrhea that was more impervious to existing antibiotics than any other strain previously recorded in the U.S.
“This is a warning and an opportunity,” said Kathleen Roosevelt, who leads the state agency’s sexually transmitted infections division. “We know gonorrhea is increasing, drug resistance is increasing and antibiotics are starting to run out.”
Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is primarily spread through sexual contact or from a mother to an infant during childbirth, according to the Centers for Disease Control and Prevention. Gonorrhea is the second-most commonly reported bacterial sexually transmitted infection in the U.S., after chlamydia, and incidence of the disease has risen sharply in recent years, the CDC said.
Almost 700,000 cases of gonorrhea were confirmed in the U.S. in 2021, a 130% increase since 2009, the CDC said. Early in the Covid-19 pandemic, reduced screening and less access to care could have contributed to longer, untreated infections in some patients and more spread, the CDC said.
Gonorrhea continues to evolve, increasing resistance to available antibiotics, infectious-disease experts said. In 2020, about half of all gonorrhea infections in the U.S. were estimated to be resistant to at least one antibiotic, the CDC said.
“There’s nothing we’ve thrown at gonorrhea that it hasn’t developed resistance to,” said Supriya Mehta, an epidemiologist at University of Illinois Chicago. “The rate of its evolution is faster than our rate of developing new drugs.”
About half of the gonorrhea infections in the U.S. in 2020 were estimated to be resistant to at least one antibiotic, the CDC said. PHOTO: BSIP/UIG/GETTY IMAGES
Bacterial and fungal resistance to antibiotics is a global public-health concern. The World Health Organization has said multidrug-resistant pathogens, or “superbugs,” could kill more than 10 million people annually by 2050 if new antibiotics aren’t developed.
The WHO and CDC said gonorrhea is among the drug-resistant bacteria of greatest public-health concern. Globally, the WHO estimates there were at least 82 million new cases of gonorrhea among people ages 15 to 49 in 2020. Gonorrhea infections are often asymptomatic, especially in women, infectious-disease experts said, allowing the bacteria to spread undetected.
Hanan Balkhy, the WHO’s assistant director general for antimicrobial resistance, said the true burden of gonorrhea’s spread and drug resistance isn’t known. Improved global surveillance is urgently needed, she said. The CDC said it has expanded its surveillance program in recent years.
Developing treatments including antibiotics and vaccines, better tests, and measures to prevent the spread of infection are criticalto ensuring gonorrhea remains a treatable disease, public-health experts said.
Gonorrhea can cause long-term complications including pelvic inflammation, infertility and ectopic pregnancies in women, scrotal pain and swelling in men, and blindness in newborns. Untreated gonorrhea increases the risk of getting or transmitting HIV. Very rarely, gonorrhea can be deadly.
The CDC recommends just one drug for the treatment of gonorrhea, the antibiotic ceftriaxone. If a patient is allergic to the drug, a combination of gentamicin and azithromycin is recommended. Cefixime is recommended if ceftriaxone isn’t available.
The superbug detected in Massachusetts had a reduced susceptibility to ceftriaxone, cefixime and azithromycin, and resistance to other antibiotics, state health officials said. The superbug had previously been identified in the U.K. and parts of Asia, officials said.
In 2019, a strain of gonorrhea was detected in Nevada that showed a lower susceptibility to ceftriaxone and cefixime, but the bacteria was susceptible to azithromycin, the CDC said.
The strains were determined to have resistance or reduced susceptibility to the antibiotics based on the lowest amount of each drug needed to prevent visible growth of bacteria in a laboratory, officials said.
The two patients in Massachusetts were successfully treated with ceftriaxone, said Katherine Hsu, medical director for the division of STD Prevention at the Massachusetts Department of Public Health. Dr. Hsu said that though the superbug showed reduced susceptibility to ceftriaxone in a laboratory, the drug still cured the patients.
“The plate is not the patient,” Dr. Hsu said.
Gonorrhea’s growing resistance to ceftriaxone means that larger amounts could soon be needed to eradicate infection and that the drug could lose its potency against the disease, the CDC said.
“The dose is now four to eight times higher than it was 30 years ago,” said Edward Hook, a sexually transmitted infections specialist at the University of Alabama at Birmingham.
GSK PLC and Innoviva Inc. are among pharmaceutical companies developing treatments for gonorrhea. GSK’s gepotidacin has been effective against uncomplicated gonorrhea infections in late-stage clinical trials. GSK said it is also developing vaccine candidates for gonorrhea.
Zoliflodacin, an oral medication developed by Innoviva’s Entasis Therapeutics, was effective at treating uncomplicated gonorrhea infections in late-stage trials. “If you get the right drug to patients at the right dose and have appropriate surveillance and monitoring, that will limit the emergence of resistance,” Innoviva CEO Pavel Raifeld said.
Patients with gonorrhea aren’t typically tested individually to see which antibiotics their infection might be resistant to, doctors said. Some strains of gonorrhea could be successfully treated with existing antibiotics, but better tests are needed to help doctors determine which drug to use, said Yonatan Grad, an infectious-disease researcher at the Harvard T.H. Chan School of Public Health.
“Instead of just one drug, we could use multiple different drugs to treat patients,” he said. “That’s one strategy to control and slow the spread of resistant strains.”
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