US records first cases of antibiotic-resistant gonorrhea

Public health officials have confirmed two cases of gonorrhea that appear to have a reduced susceptibility to all types of antibiotics available for treatment. It is the first time that antibiotic-resistant strains of gonorrhea have been identified in the United States.

The increase in sexual activity during the pandemic, combined with the reduction in routine health checks, has amplified the spread of sexually transmitted infections (STIs) around the world.

These infections, including gonorrhea, are becoming increasingly resistant to the antibiotics available to treat them, a problem that is becoming a dire public health threat.

Globally, antibiotic-resistant infections kill approximately 700,000 people each year. That number could rise to 10 million deaths per year by 2050 if measures are not taken to stop the spread of resistant organisms.

Experts say it was never a question of “if” this highly resistant strain of gonorrhea would reach the United States, but “when.”

“The concern is that this particular strain had been circulating around the world, so it was only a matter of time before it reached the United States,” says Jeffrey Klausner, clinical professor of public health at the Keck School of Medicine at the University of Southern California, from Los Angeles.

“It’s a reminder that gonorrhea is becoming more and more resistant, more and more difficult to treat. We don’t have new antibiotics. We haven’t had new antibiotics to treat gonorrhea for years, and we really need a different treatment strategy,” said Klausner, who is part of the CDC’s Working Group on Gonorrhea Treatment.

Gonorrhea is sexually transmitted and one of the most commonly diagnosed infections in the US. It is caused by bacteria Niesseria gonorrhoeaewhich can infect the mucous membranes of Organs genitals, rectum, throat and eyes.

People can be infected without showing symptoms. If left untreated, the infection can cause pelvic pain and infertility in women and blindness in newborns.

In addition to reduced susceptibility to ceftriaxone, gonorrhea strains identified in Massachusetts also showed reduced susceptibility to cefixime and azithromycin Strains were shown to be resistant to ciprofloxacin, penicillin and tetracycline, according to a clinical alert sent to clinicians by the Massachusetts Department of Public Health .

The department says it has yet to find any connection between the two cases.

In 2021, the US Centers for Disease Control and Prevention (CDC) recommended administering a double dose of the antibiotic ceftriaxone in an effort to overcome the bacteria’s growing resistance to this antibiotic. The measure seems to have worked in these cases, but this antibiotic is the last line of defense against this infection, and experts say a new approach is needed.

Klausner hopes to get approval from the US Food and Drug Administration (FDA), an agency similar to ANVISA, for a test that would tailor antibiotic treatment to the genetic susceptibilities of the specific strain of gonorrhea that is infecting a person. This is called resistance-guided treatment, and Klausner says it works for HIV, tuberculosis and some other hospital-acquired infections, but has never actually been tested for gonorrhea.

This strain of gonorrhea has been seen in Asia-Pacific countries and the UK, but not in the US until now. A genetic marker common to these two Massachusetts residents was also previously seen in a case in Nevada, although that strain retained sensitivity to at least one class of antibiotics.

The first symptoms of gonorrhea are usually painful urination, abdominal or pelvic pain, increased vaginal discharge or bleeding between periods, but many infections are asymptomatic, according to the CDC, making routine screenings important to detect the infection.