Super Gonnorhea

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Super Gonorrhea Resists Antibiotics

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In post-apocalyptic imaginings, viral hemorrhagic fever and zombies win out, but don't underestimate antibiotic resistance. After all, if our antibiotics lose the war against bacteria, we're looking at the aftermath of a public health Armageddon. Although not deadly per se, gonorrhea is definitely uncomfortable and causes inflammation and infection of the endothelium lining your reproductive organs and rectum (think blood, swelling and pus). Right now U.S. physicians treat gonorrhea with cephalosporins which are our first and last main defense against the bacteria. To make matters worse, super gonorrhea has emerged that is resistant to cephalosporins.

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What Is Gonorrhea?

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Gonorrhea is a sexually transmitted (STI) infection unique to the human beings. It's a gram-negative bacteria. In many people, it causes no symptoms. These people then spread the disease unknowingly. However, in others, gonorrhea causes discharge, inflammation, and pain to the endothelial linings of the mouth, anus, and reproductive organs. If left untreated, in women, gonorrhea attacks internal organs like the ovaries, uterus, fallopian tubes and liver; in men, it infects the epididymis and urethra (pee tube). Like other STIs, gonorrhea makes it easier to become infected with the HIV virus by way of inflammation and breaks in the skin.

Gonorrhea is a scary pathogen because, by either chromosomal mutation or plasmid acquisition, it mutates quickly and alters its antigenic structure in order to resist antibiotics. Ever since sulfonamides were used to fight gonorrhea in the 1930s, this pathogen has developed resistance to penicillin, spectinomycin, tetracycline, and floroquinolones. Now, super gonorrhea has shown up that is resistant to cephalosporins like Rocephin which are our only sure shot treatment for the disease.

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Cephalosporin Resistance and Gonorrhea

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In 2012, the CDC and WHO revised their guidelines to recommend azithromycin and ceftriaxone (Rocephin) to treat gonorrhea. Researchers worry that treating everyone with Rocephin, a third-generation cephalosporin, increases the likelihood that gonorrhea will develop a resistance that will take hold. Once this happens, we're left with no truly effective means to treat gonorrhea.

During the past several years, super gonorrhea or gonorrhea resistant or less susceptible to cephalosporins has shown up in the United States and abroad. In 2007, a cephalosporin-resistant gonorrhea emerged in Japan and Australia. In 2008, a strain of gonorrhea less susceptible to cephalosporin was detected In the United States. And in 2012, gonorrhea resistant to Rocephin (our only good treatment) was discovered in Japan. Finally, according to the Gonococcal Isolate Surveillance Project (GISP), in 2012 the percentage of gonococcal isolates that exhibited decreased susceptibility--more specifically, elevated ceftriaxone minimum inhibitory concentrations (MICs)--was 0.3% which is up from 0.1% in 2008.

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What Can We Do About Super Gonorrhea?

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According to an article titled "Stemming the tide of drug-resistant Neisseria gonorrhea: the need for an individualized approach to treatment" in the Journal of Antimicrobial Chemotherapy, before we develop a vaccine for gonorrhea, physicians need to use drugs other than Rocephin to treat the disease. In order to figure out which alternative drugs to use, we need to develop a quick in-office diagnostic test that allows physicians to tell the genotype and drug-resistance phenotype of an individual patient's strain of gonorrhea and prescribe accordingly. Drugs like the combination amoxicillin, azithromycin, and probenecid to which a verified gonococcal strain bears no resistance.

Currently, the near unanimous decision by clinicians to jump to cephalosporin treatment is because clinical guidelines are based on population analysis not individual or small community prevalence patterns. For example, homosexual men are more likely to become infected with gonorrhea that has higher resistance to antibiotics.

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Selected Sources

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"Stemming the tide of drug-resistant Neisseria gonorrhea: the need for an individualized approach to treatment" by S.A. Buono and colleagues from the Journal of Antimicrobial Chemotherapy published October 14, 2014.  Accessed from PubMed on 10/24/2014.

Ram S, Rice PA. Chapter 144. Gonococcal Infections. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 18e. New York, NY: McGraw-Hill; 2012. Accessed October 25, 2014. 

"Antimicrobial resistance for Neisseria gonorrhoeae in the United States, 1988 to 2003: the spread of fluoroquinolone resistance" by S.A. Wang and colleagues from the Annals of Internal Medicine published July 17, 2007.  Accessed from PubMed on 10/25/2014.

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