Drug-resistant gonorrhoea has spread across the world, say health officials

Drug-resistant gonorrhoea has spread across the world, say health officials | Society | guardian.co.uk.

Gonorrhoea ‘superbug’, resistant to almost all antibiotics, has become global threat with cases found in countries including UK

• Reuters
• guardian.co.uk, Wednesday 6 June 2012 14.44 BST

The strain of gonorrhoea discovered in Japan in 2008 is resistant to drugs including cephalosporin antibiotics – normally the last option against the disease. Photograph: Murdo Macleod

Drug-resistant strains of gonorrhoea have spread to countries across the world, the United Nations health agency says, and millions of patients may run out of treatment options unless doctors catch and treat cases earlier.

Scientists reported last year finding a “superbug” strain of gonorrhoea in Japan in 2008 that was resistant to all recommended antibiotics and warned then that it could transform a once easily treatable infection into a global health threat.

The World Health Organisation (WHO) said those fears were now reality with many more countries, including Britain, Australia, France, Norway and Sweden, reporting cases of the sexually transmitted disease resistant to cephalosporin antibiotics – normally the last option for drugs against gonorrhoea.

“Gonorrhoea is becoming a major public health challenge,” said Manjula Lusti-Narasimhan, from the WHO’s department of reproductive health and research. She said more than 106 million people were newly infected with the disease every year.

“The organism is what we term a superbug – it has developed resistance to virtually every class of antibiotics that exists,” she told a briefing in Geneva. “If gonococcal infections become untreatable, the health implications are significant.”

Gonorrhoea is a bacterial sexually transmitted infection which, if left untreated, can lead to pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies, and infertility in both men and women.

It is one of the most common sexually transmitted diseases in the world and is most prevalent in south and south-east Asia and sub-Saharan Africa. In the United States alone, according to the Centers for Disease Control and Prevention (CDC), the number of cases is estimated at around 700,000 a year.

The WHO called for greater vigilance on the correct use of antibiotics and more research into alternative treatments for so-called gonococcal infections.

The emergence of drug-resistant or superbug strains of gonorrhoea is caused by unregulated access to and overuse of antibiotics, which helps fuel natural genetic mutations within the bacteria.

Experts say an added problem with gonorrhoea is that its strains tend to retain their genetic resistance to previous antibiotics even after their use has been discontinued.

Major producers of antibiotics for gonorrhoea include GlaxoSmithKline, Pfizer and Abbott, as well as Indian firms such as Cipla.

The WHO said it was not yet clear how far or wide drug resistance in gonorrhoea had spread, as many countries lack reliable data. “The available data only shows the tip of the iceberg,” said Lusti-Narasimhan.

“Without adequate surveillance we won’t know the extent of resistance … and without research into new antimicrobial agents there could soon be no effective treatment for patients.”

Francis Ndowa, formerly the WHO’s lead specialist for sexually transmitted infections, said gonorrhoea had not only adapted to elude antibiotics but developed less painful symptoms, increasing its survival chances.

“They used to say that if you have urethral gonorrhoea and you go to the toilet to pass urine, it would be like passing razor blades. It was that painful,” he explained. “Now people with gonorrhoea sometimes … only notice the discharge if they look when they pass urine. It’s not that painful any more.

“So the organism has re-adjusted itself to provide fewer symptoms so that it can survive longer. It’s an amazing interaction between man and pathogen.”

Experts say the best way to reduce the risk of even greater resistance developing – beyond the urgent need to develop effective new drugs – is to treat gonorrhoea with combinations of two or more types of antibiotic at the same time.

This technique is used in the treatment of some other infections such as tuberculosis in an attempt to make it more difficult for the bacteria to learn how to conquer the drugs.

Gonorrhoea can be prevented through safer sexual intercourse. The WHO said early detection and prompt treatment, including of sexual partners, is essential to control sexually transmitted infections.

Related articles

• Gonorrhoea becoming untreatable, health experts warn (purestrange.wordpress.com)
• Sexually transmitted infection rates soar among young (guardian.co.uk)
• Why having sex with young men can be bad for your health (thisislondon.co.uk)

Sex Parasite Is Most Common in Women Older Than 40, Study Finds

A sex disease that’s more prevalent than gonorrhea and chlamydia, and less well-known, is suffered by 13 percent of women aged 50 and older, a study found.

The sexually transmitted parasite Trichomonas vaginalis causes urogenital infection, and can raise susceptibility to HIV. A study, reported at the International Society for STD Research in Quebec City, found the infection is twice as prevalent in those over 40 than in younger women because it isn’t adequately screened for. Women in their 40s had an 11 percent infection rate, according to the data.

Most STDs are more common in young people, said the study’s senior author, Charlotte Gaydos, a professor at Johns Hopkins University School of Medicine. Instances of syphilis, gonorrhea and chlamydia must be reported by doctors to state and federal health officials. There’s no mandate to do that for Trichomonas even though an estimated 7.4 million new cases occur every year.

“It’s not a reportable disease, although it’s more prevalent than chlamydia and gonorrhea combined,” Gaydos said in a telephone interview. “Maybe we should make this reportable and get good data.”

The study, of 7,593 U.S. women aged 18 to 89 in 28 states, showed an 8.3 percent overall infection rate among women. Testing is needed because most infected people show no symptoms, according to the study.

In men, the parasite is usually asymptomatic, according the U.S. Centers for Disease Control and Prevention in Atlanta. In women, infection can also cause pelvic inflammatory disease, vaginal discharge and low birth weight babies.

Single-Cell Protozoan

For a long time it was difficult to test for Trichomonas, because doctors had to grow the parasite in culture or see it in a sample. The organism, a single-cell protozoan, doesn’t survive well outside the body, so those tests were inaccurate about half the time, Gaydos said.

Gen-Probe Inc. (GPRO) of San Diego manufactures a test for the disease now, she said. She was involved in the clinical trials for the test’s regulatory approval. The test was approved April 20 by the U.S. Food and Drug Administration.

Gen-Probe provided tests but did not fund the study, Gaydos said.

Sex Parasite Is Most Common in Women Older Than 40, Study Finds – Bloomberg.

Scientists to tackle mutant gonorrhea ‘superbug’ at Que. conference

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MONTREAL — Worried scientists have confirmed with the World Health Organization that a new, mutant strain of gonorrhea has been isolated in a sex trade worker in Japan.

The first strain of a common sexually transmitted infection once easily treated with penicillin and other antibiotics has mutated into a “superbug” able to withstand all forms of known treatment, said Swedish researcher Magnus Unemo, who recently isolated the strain. He will be presenting his team’s findings on Monday at a meeting of the international conference on sexually transmitted diseases, held in Quebec City.

“If it spreads now, we don’t know what should be the recommended treatment,” Unemo said.

An entire symposium at the meeting of the International Society for Sexually Transmitted Diseases Research —_which attracts experts from microbiology, virology and immunobiology, behavioural sciences, public health and prevention policy — will be devoted to the subject.

A smart bacteria, Neisseria gonorrhoeae has shown that it can adapt and evolve every 10 to 15 years, quickly becoming impervious to current front-line drug therapy, explained Unemo, of the Swedish Reference Laboratory for Pathogenic Neisseria, Orebro University Hospital, Sweden.

Historically, new strains have emerged in the western Pacific region, Japan or Korea, and then rapidly spread globally.

This new strain, dubbed H041, has proven resistance to the last remaining treatment option available, cephalosporins, a fourth generation class of antibiotics.

Unemo warns of a “future era of untreatable gonorrhea.”

“Highly resistant” gonorrhea is a major threat to public health, Unemo said.

“It’s really worrying from a public health perspective. It’s shown its capacity to act as a superbug. We need to focus on finding new strategies for treatment,” Unemo said in a telephone interview last week, during a break from meetings with experts at the Centers for Disease Control and Prevention, in Atlanta, Georgia.

According to the CDC, there is an estimated 700,000 new cases of gonorrhea in the U.S. each year.

To date, the new strain has been isolated in one sex worker, Unemo said. Molecular testing, commonly used to identify whether someone has contracted the disease, however, does not detect whether the bacteria is antibiotic-resistant, Unemo said. “So it’s really hard to know how far this strain has spread.

“Due to this situation, the World Health Organization has assured us that it will work on the issue of coming up with a global response plan — a huge challenge for the future,” Unemo said, starting with surveillance of the new disease, better infection prevention approach, treatment options such as combining of two or more antibiotics, development of a fast and effective drug, and ideally, a vaccine.

Health Canada is also taking the matter seriously and has organized a workshop on the matter at the conference.

Gonorrhea can show up without symptoms in 50 per cent of infected women. Most infected men find it extremely painful (about two to five per cent do not have symptoms) and describe it as urinating razor blades.

Untreated, gonorrhea can lead to severe, life-threatening complications if it spreads to the blood and the joints, in both men and women.

Untreated women run the risk of developing pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancies, as well as passing the infection to their babies during birth, which can cause life-threatening infections and blindness.

Gonorrhea is one of the most commonly circulating STDs, which is why this discovery is so important, said Dr. Michel Alary, president of the International Society for Sexually Transmitted Diseases Research and researcher at the Centre hospitalier affilie universitaire de Quebec.

“The big fear is that if the strain becomes dominant, there will be a real problem,” Alary said. “It’s not treatable.”

Montreal Gazette

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Scientists to tackle mutant gonorrhea ‘superbug’ at Que. conference.