- The Washington Times - Thursday, August 9, 2012

Americans who test positive for gonorrhea should now be treated with a shot, not just pills, the federal government said Thursday in a significant rewrite of the recommended treatment for the long-dreaded sexually transmitted disease.

The shift is prompted by evidence that the gonorrhea bacterium is rapidly building resistance to cefixime, an anti-gonorrhea oral antibiotic that was once highly effective against the disease, the Centers for Disease Control and Prevention (CDC) said.

Now instead of taking cefixime pills, patients should receive a shot of ceftriaxone, which is still effective against gonorrhea, plus a round of general antibiotics, either azithromycin or doxycycline.

“This change is a critical pre-emptive strike to preserve ceftriaxone, our last proven treatment option” against gonorrhea, said Dr. Kevin Fenton, director of the National Center for HIV/AIDs, Viral Hepatitis, Sexually Transmitted Disease (STD) and Tuberculosis Prevention at the CDC.

It “may buy us time” to find a new class of anti-gonorrhea drugs, said Dr. Gail Bolan, director of the STD prevention division at the Centers for Disease Control and Prevention (CDC).

Gonorrhea, which has plagued mankind since biblical days, first became curable with the introduction of sulfa drugs in the 1940s.

However, the bacterium, Neisseria gonorrhoeae, is a master of mutation, and over the decades, it has learned how to survive several classes of drugs, including penicillins, tetracyclines and fluoroquinolones.

In the last five years, the mutated disease has proven too powerful for drugs in the cephalosporins class; with Thursday’s announcement, only the ceftriaxone shot is considered a front-line defense.

The change means that new anti-gonorrhea medicines must be found quickly, and budgets and staff of state STD health agencies must be replenished, said William Smith, executive director of the National Coalition of STD Directors (NCSD).

Treatment of gonorrhea has now shifted from a simple act of taking pills to getting an injection by a certified health professional, said Mr. Smith. In addition to meeting this new need, NCSD health departments, which have “bare bones” budgets, will also be expected to ensure that gonorrhea patients are fully cured, as well as find, test, treat and re-test a patient’s sex partners of the previous 60 days.

“In the face of this real and emerging threat, federal, state and local governments must reinvest in health department STD programs without delay,” said Mr. Smith.

CDC officials said Thursday that no cases of “treatment failure” have been found in the U.S., but several cases have been reported in Asia and Europe. One gonorrhea “superbug,” dubbed H041, which didn’t respond to known antibiotics, was found in the throat of a sex worker in Japan.

According to a CDC computer model, if antibiotic-resistant gonorrhea cases continue to rise in the United States without additional remedies, the nation could expect to see its gonorrhea caseload leap from the current 600,000 to 5.9 million in seven years.

The new gonorrhea guidelines were published in the new Morbidity and Mortality Weekly Report.

With an estimated 600,000 new cases each year, gonorrhea is the second most commonly reported STD in the United States. Only about half of infections are reported because gonorrhea is often asymptomatic, especially in women, and particularly when the infection is in the throat or rectum.

Gonorrhea rates are highest in the Southeast, and sections of California, South Dakota and Alaska. Black men and women, and men who have sex with men are overrepresented in the caseload.

When gonorrhea symptoms appear, they include genital discharge, itching, burning during urination and open sores on the skin. Left untreated, gonorrhea damages reproductive organs and can make it easier to acquire HIV/AIDS.

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