For decades, gonorrhea patients could expect to quickly dispatch the long-dreaded sexually transmitted disease with a time-tested round of antibiotics.
But the ever-mutating gonorrhea bacterium is becoming resistant to the dwindling number of medicines used to fight it, and public health authorities are raising alarms about the emergence of an untreatable “superbug” that will reverse decades of progress in lowering infection and transmission rates around the globe.
On Thursday, officials with the Centers for Disease Control and Prevention (CDC) are scheduled to release new treatment guidelines to slow the growth of antibiotic-resistant gonorrhea in the United States.
These guidelines are coming none too soon, said William Smith, executive director of the National Coalition of STD (Sexually Transmitted Disease) Directors.
“It is pretty clear that we have already seen significant resistance to the existing [gonorrhea] treatments, and internationally, we have seen complete treatment failures,” he said. “So right now is the time to be just ahead of this, and to try and figure out how we can control it a bit longer with the existing resources that we’ve got.”
“Complete treatment failure,” Mr. Smith said, means just what it sounds like — “that you have a chronic, active, ulcerative, infectious disease.”
Gonorrhea, which has been known since biblical days, was a global scourge until the 1940s, when sulfa drugs were developed to vanquish it.
But the bacterium, Neisseria gonorrhoeae, proved to be a master of mutation. Over time, it learned how to survive against entire classes of antibiotics, including penicillins, tetracyclines and fluoroquinolnes.
Now only two drugs — ceftriaxone or cefixime — are recommended to treat gonorrhea. Both usually are fortified with another antibiotic.
In recent years, however, cases of complete treatment failure have been reported in Europe, Asia and Canada.
In July 2011, researchers said a gonorrhea strain, named H041, was identified in the throat of a Japanese sex worker.
The H041 strain was dubbed a “superbug” because it was resistant to all known antibiotics. When researchers cultivated it with other gonorrhea strains, it produced even more resistant strains of the sexually transmitted infection.
Antibiotic-resistant gonorrhea is “a major global threat,” Dr. Edward W. Hook III told a CDC webinar in May.
If this gets out of control, it “could take us back more than 60 years, to a time when treatments for gonorrhea were not reliably effective and when there were no alternative therapies,” said Dr. Hook, a professor of medicine and epidemiology at the University of Alabama and director of the STD Control Program for the Jefferson County Department of Health.
The federal government estimates that 600,000 cases of gonorrhea are diagnosed in the U.S. each year; roughly half are not reported.
In the District, some 10,000 gonorrhea cases, including 4,000 among teens, have been reported, but, based on clinic information and outreach efforts, “we are not aware of any cases” that have not been cured, said Michael Kharfen, bureau chief for communications and community outreach in the District of Columbia Department of Health.
“We’re looking forward very much” to the new CDC guidelines on antibiotic-resistant gonorrhea, Mr. Kharfen said Tuesday. “We’re obviously concerned because we’ve been seeing over the years a shrinking number of effective treatments.”
Seeking new cures
Meanwhile, there is an increasingly urgent need to find an entirely new class of drugs to defeat gonorrhea, as previously used antibiotics are ineffective and cannot be reintroduced, researchers told the CDC webinar.
It takes drug manufacturers at least nine years and up to 15 years to get a licensed product. Speculative research and development costs can range from $4 billion up to $12 billion, Carolyn Deal, chief of the STD branch of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told the CDC webinar.
Gonorrhea, known historically by such terms as “the clap,” “drip” or “GC,” often goes unreported because it is asymptomatic, especially in women, and particularly if the infection is lodged in the oral cavity or rectum, STD researchers said. When there are symptoms, these usually include painful urination, discharge and itching.
Left untreated, gonorrhea can lead to scarring of reproductive tissues, which can cause infertility. It ulcerates or opens sores on the skin, raising the risk for acquiring HIV and other STDs. Pregnant women infected with gonorrhea are at risk for miscarriage, premature birth and other complications; infected mothers can transmit the disease to their babies, causing eye infections and other problems.
The best ways to avoid gonorrhea are to abstain from sex or stay in a monogamous relationship with an uninfected partner and use condoms consistently and correctly, Dr. Robert Kirkcaldy, a medical epidemiologist at the STD division of the CDC, told the webinar. Anyone who acquires gonorrhea, he said, should let the health care provider know if the infection is not resolved and notify all recent sex partners so they can be treated too.
With more than 600,000 new infections each year in the United States, gonorrhea ranks as the second most commonly reported bacterial STD after chlamydia. After infection rates fell steadily from the mid-1970s to the mid-1990s, infection rates essentially have held steady since then as the more treatment-resistant strains appeared. According to the CDC, the highest reported rates of infection in the U.S. population are among sexually active teenagers, young adults and blacks.