March 8, 2002
By Stephanie Whyche
InteliHealth News Service
Doctors and public health officials are having to pay more attention these days to an old nemesis — gonorrhea.
The U.S. Centers for Disease Control and Prevention is warning that a new strain of the disease — resistant to the most common drug used against it, Cipro — is appearing on the West Coast of the United States. That means physicians will have to employ other antibiotics to fight it.
"Yes, we continue to be challenged (not just in sexually transmitted infections) by resistance to antibiotics," said Ronald O. Valdiserri, M.D., M.P.H., deputy director of the CDC's National Center for HIV, STD, and TB Prevention. He was speaking at the National Conference on Sexually Transmitted Diseases, meeting in San Diego.
Moreover, some cities are seeing a rapid growth in the number of gonorrhea cases, even as the numbers for the nation as a whole remain stagnant.
"Our point in highlighting these cities is not to suggest that local health officials are not taking steps to prevent gonorrhea infection," Dr. Valdiserri said, "but rather to note that these cities are facing challenges in their efforts to reduce gonorrhea."
CDC researchers Susan Conner and Susan Wang, M.D. reported at the conference that the new strain of gonorrhea is creeping into the West Coast. The strain is resistant to the antibiotic Cipro, the foremost treatment for the disease, and which is more famously known for its use in the recent anthrax scare.
The researchers reported that, from 1991 to 2000, 41 new cases of Cipro-resistant gonorrhea cases have been found — including 10 in Seattle, five in San Francisco, seven in Orange County, Cal., and five in San Diego. The researchers said that there is evidence that this strain, prevalent in Asia and in Hawaii for years, is being brought into the continental United States by travelers.
Cipro remains one of the CDC recommended treatments. But there's growing concern that it and other fluoroquinolone antibiotics, including ofloxacin and levofloxacin, may lose the battle against gonorrhea the way that penicillin and tetracycline lost the battle in the early 1980s.
"The issue is about maintaining a vigilance," Stuart Berman, M.D., chief of epidemiology and surveillance branch of the CDC's division of STD Prevention, said at a press conference. "No matter where you are in this country, and regardless of which type of strain of gonorrhea you have, there are effective treatments as long as you are aware of the local resistant pattern. And having information about that local resistant pattern allows clinicians to make the right decisions about the right drugs to use."
The CDC specifically recommends that doctors of patients with laboratory confirmed cases of Cipro-resistant gonorrhea treat the infection with another antibiotic class, cephalosporin. Among this class of antibiotics are cefixime (brand name Suprax) and ceftriaxone (brand name Rocephin) The agency also advises doctors to consider using these alternative treatment for patients with unconfirmed cases of this strain of gonorrhea but whose travels and health history suggests they may have contracted the disease in the Far East.
CDC also reported at the conference that rates of the disease rose in 13 of the 20 cities in the United States hardest hit by gonorrhea between 1999 and 2000. There was a 20 percent increase in the disease in 2000 in five of the cities that already had the highest rates of infection in 1999.
Those cities were: Kansas City, Mo. (with an increase of more than 37 percent), Buffalo, N.Y. (over 27 percent), Jacksonville, Fla. (more than 22.5 percent), Detroit (over 21 percent), and Birmingham, Ala. (around 21 percent).
Gonorrhea is a sexually transmitted disease in which the bacterium Neisseria gonorrhoeae is passed from one individual to another through sexual intercourse or other sexual activity, such as oral and anal sex.
According to the CDC, about 650,000 new cases of gonorrhea are reported each year in the United States.
The bacteria can infect the cervix, vagina and urethra in women. In men it can infect the penis, prostate and testes. Both sexes can develop gonorrheal infections of the anus or rectum as a result of anal intercourse, and of the throat and pharynx as a result of oral sex. In a few cases the bacteria has entered the bloodstream and spread to the heart or the brain.
