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article imageGonorrhea rates increased in the U.S. 1991-2006

By Tim Sandle     Mar 14, 2014 in Health
Washington - Rates of an antibacterial resistant form of the sexually transmitted disease gonorrhea increased in cities around the U.S., between 1991 and 2006, according to a new study commissioned by the U.S. Centers for Disease Control and Prevention (CDC).
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The resultant disease can cause pelvic pain, pain on urination, penile, and vaginal discharge, as well as systemic symptoms in human infection. The disease can also cause conjunctivitis. The most common association with the infection is with burning with urination and discharge from the penis. The incubation period is 2 to 14 days, with most of these symptoms occurring between 4 and 6 days after being infected. Gonorrhea if left untreated may last for weeks or months with higher risks of complications. One of the complications of gonorrhea is systemic dissemination resulting in skin pustules or septic arthritis.
Gonorrhea is the second most commonly reported infectious disease in the United States. In 2008, there were 336,742 official cases; 2013 estimates placed the number of cases closer to 820,000. This could be an under estimated for not all of those who are infected know it, contributing to the problem. Undiagnosed cases, or infections that are unsuccessfully treated and then linger without obvious symptoms, can create serious health problems.
Treatment with penicillin, for many years proved to be effective. However, during the 1970s resistant strains began to be reported. Fluoroquinolones were a useful next-line treatment until resistant strains were detected. In some cases, third-generation antibiotics called cephalosporins are used to treat gonorrhea. This means that today the common treatment is with ceftriaxone (Rocephin). This is typically given in combination with either azithromycin or doxycycline. A potential side-effect of the medication is internal bleeding.
The bacterium has proved to be "remarkably adept" at developing resistance to the drugs used to treat it and the concern is that one day the bacterium may become resistant to cephalosporin. If this was the case, then this could significantly complicate the ability of healthcare providers to treat gonorrhea successfully. Resistance could also become an issue in other bacterial STDs.
About 30 percent of females who contract gonorrhea are co-infected with Chlamydia. While Chlamydia seems to respond well to medication so far, a small number of strains have shown signs of developing drug-resistance. With people testing positive for gonorrhea, most clinics test for other sexually transmitted diseases such as Chlamydia, syphilis, and human immunodeficiency virus.
During the period 1991-2006, the rate of resistance steadily increased. The CDC study found that rates of so-termed 'super-gonorrhea' occured in several cities, including Denver, Honolulu, Minneapolis, Phoenix, Portland, San Diego, San Francisco, and Seattle. This was because the bacterium became resistant to ciprofloxacin, which was then a common drug to treat gonorrhea.
For the study, the research team charted the point where resistant strains of the disease where reported - in Hawaii and California - and then they proceed to track the spread of the disease across the U.S. For this study, the researchers analyzed rates of gonorrhea and resistant gonorrhea in 17 cities between 1991 and 2006.
The researchers found that gonorrhea was more common in the cities with lower resistance. However, what was of greatest concern was that rates of gonorrhea were sharply rising in the cities with higher levels of resistance strains of the bacteria. Data analysis revealed that when 10% of gonorrhea cases are resistant, there is an associated 7% spike in the incidence of gonorrhea.
Although the use of ceftriaxone is currently effective, the CDC states that it is critical to continuously monitor antibiotic resistance in Neisseria gonorrhoeae and encourage research and development of new treatment regimens. Another area, and one slightly controversial is with screening. The United States Preventive Services Task Force recommends screening for gonorrhea in women at increased risk of infection, which includes all sexually active women younger than 25 years. It is not recommended in males without symptoms or low risk women. Where cases are detected, it is recommended that sexual partners be tested and potentially treated.
In terms of sexual health, transmission can be reduced by the usage of latex barriers, such as condoms or dental dams, during intercourse, oral and anal sex. Longer-term, vaccines are thought to be an important goal in the prevention of infection. However, there has been a relatively low emphasis on research to such a vaccine in the medical literature and few human clinical trials for prospective vaccines.
The research has been published in the April 2014 issue of Emerging Infectious Diseases.
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