Drug-Resistant Gonorrhea Spreading In North America

Gonorrhea is one of the most common sexually transmitted infections, with more than 100 million cases per year worldwide. Also known as "the clap," it can be spread by contact with an infected person's mouth, vagina, penis or anus. Signs of gonorrhea include a burning sensation during urination and discharge from the genitals, but in some cases, a person exhibits no symptoms. If left untreated, gonorrhea can lead to scarring of the urethra or fallopian tubes, meningitis, infertility and heart valve infections.

A strain of gonorrhea able to dodge the most common treatment, the oral antibiotic cefixime, was first discovered in Japan several years ago and has since spread throughout Asia and Europe.

“An era of untreatable gonorrhea may be approaching, which represents an exceedingly serious public health problem,” World Health Organization officials warned in a December article in the journal Future Microbiology.

Now, a new study published in the Journal of the American Medical Association confirms that cefixime resistance is cropping up in North America at an alarming rate. The researchers examined 291 people that came into a Toronto health clinic with gonorrhea infections. Of the 133 patients that returned for a follow-up examination, nearly 7 percent did not respond to treatment.

For decades, the bacteria Neisseria gonorrhoeae has developed the ability to evade cures that humans throw at it. It became resistant to sulfonamides in the 1940s. Next to fail were penicillins and tetracyclines in the 1970s and 1980s. By 2007, another class of drugs, the fluoroquinolones, proved ineffective in the U.S. The cephalosporins -- cefixme and ceftriaxone -- have been our last line of defense since then.

The results of the JAMA study could be a bit skewed, since the clinic observed primarily serves men who have sex with men, a group in which drug-resistant gonorrhea is more common. But judging by the spread of past sexually transmitted infections, including the AIDS epidemic, there’s every reason to expect the disease should and will be a universal pubic health concern. In Europe, sexually transmitted infections including gonorrhea have been on the rise in all kinds of demographic groups since the early 2000s.

Researchers have found that in Sweden, half of the diagnoses of gonorrhea in heterosexual men seem to be acquired outside of the country, illuminating potential import pathways for antimicrobial resistant strains.

“The rise in gonorrhea among heterosexuals in Sweden and the UK in particular cannot be linked solely to increased testing, and unsafe sexual behavior is an important contributor,” European Center for Disease Prevention Control officials wrote last July.

Health agencies in the U.S. and abroad have seen the warning signs of the threat for years, as doctors had to use increasingly higher concentrations of cefixime to knock out N. gonorrhoeae.

Last August, the U.S. Centers for Disease Control and Prevention changed its recommendations for treating gonorrhea in an effort to stem the rising levels of drug resistance. Instead of using cefixime as a first-line treatment, the CDC said doctors should instead use a combination therapy with ceftriaxone and another antibiotic, like azithromycin or doxycycline.

By scaling back the use of cefixime, public officials hope to create a less resistance-prone environment for the gonorrhea bacteria. Heavy antibiotic use, especially if there’s just one or two drugs aimed at a bug, tends to lead to antibiotic resistance as drug resistant mutants arise and quickly find themselves kings of the microbial mountain.

But now, with the global spread of drug-resistant gonorrhea only further solidifying, changing treatment recommendations may only be a stopgap measure, public health officials warn.

“Reinvestment in gonorrhea prevention and control is warranted. New treatment options for gonorrhea are urgently needed,” the CDC wrote.