Massachusetts discovers troubling new strain of gonorrhea
“We are approaching an era in which [patients] they may no longer respond” to the drug, said Dr. Katherine Hsu, medical director of the Massachusetts Department of Public Health’s Division of STD and HIV/AIDS Prevention.
The discovery comes as sexually transmitted infections, particularly gonorrhea, are on the rise across the country and the ability of many microbes to outsmart the drugs used to kill them is a growing concern.
“We have very few – very few – options. “The concern is that we’re going to get to a point where there’s no option,” said Dr. Helen Boucher, chief academic officer of Tufts Medicine Health System and a member of the President’s Advisory Council on Antibiotic-Resistant Bacteria. “This is a common infection in young healthy people. … There’s only one thing, and that one thing might not work anymore.”
dr. Ruanne Barnabas, head of the Division of Infectious Diseases at Massachusetts General Hospital, called the discovery of the strain “significant.”
“But given how mobile we are as a global community, that’s not surprising,” she said.
The news from Massachusetts should serve as a warning to doctors and patients to take gonorrhea seriously and watch for signs of resistance, said Dr. Laura Bachmann, chief medical officer of the CDC’s Division of Sexually Transmitted Disease Prevention.
The Centers for Disease Control and Prevention and state health officials sent alerts to providers Thursday afternoon. The Massachusetts alert says the discovery is a warning that gonorrhea is “becoming less susceptible to a limited arsenal of antibiotics.”
“The message to providers is, ‘hey, we’ve got to keep an eye on this,'” Bachmann said. “Antimicrobial resistance is an important and urgent threat to public health.”
However, the CDC has not changed its recommendations for testing and treating gonorrhea. Bachmann called it “encouraging” that both Massachusetts patients were cured with the standard treatment, a single injection of ceftriaxone.
The strain is circulating in the Asia-Pacific region, with 10 cases recently identified in the United Kingdom. Patients from the UK were also cured with ceftriaxone.
If ceftriaxone stops working, there are alternative drugs, but they carry greater risks or are less effective, doctors say.
“We want to keep the options we have,” Barnabas said.
She added that a potential vaccine is under development.
Several new antibiotics are in the pipeline that could work, but “economic realities” are slowing progress, and companies working on them are failing, Boucher said.
Gonorrhea is a common sexually transmitted infection that spreads quickly. Its frequency increased by 45 percent from 2016 to 2020, and more than half of those infected are between the ages of 15 and 24. In Massachusetts, laboratory-confirmed cases of gonorrhea have quadrupled from a low of 1,976 cases in 2009 to 8,133 in 2021. The bacteria that cause it infect the mucous membranes of the reproductive tract and urethra in women and men, as well as the mouth, throat, eyes and rectum.
In many cases, infected people have no symptoms, which is why the CDC recommends screening for sexually active people. When symptoms do occur, they may include painful urination and discharge from the urethra or vagina.
If left untreated, gonorrhea can lead to pelvic inflammatory disease and infertility in women, and inflammation of the scrotum in men. Over time, it can spread into the blood and cause inflammation of the tendons, joints, brain or heart.
The Massachusetts cases were discovered as part of a routine testing process. The primary care physician performed a standard test to identify gonorrhea and also had a sample cultured. After culture identified the infection as gonorrhea, an isolate of the organism was sent to the State Laboratory, which performed further drug resistance testing.
The sample showed signs of resistance, so the state sent it to the CDC for more advanced testing, which identified a troubling genetic pattern: The bacteria were resistant to ciprofloxacin, penicillin and tetracycline and had reduced susceptibility to ceftriaxone, cefixime and azithromycin.
This prompted the health department to ask clinical laboratories in the same region to send it additional samples from around the same time period. Further testing at the CDC revealed a second case.
Health officials have not found any connection between the two cases, and Barnabas said that more than two people must have been infected with the new strain. But there is no information to show how widespread the new bug might be. A similar strain that was not as resistant was identified in Nevada in 2019, but has never been seen again.
“We can’t be sure without increasing surveillance efforts,” Hsu said, and now is “a critical proactive moment for public health.”
It’s possible the strain is circulating elsewhere, Bachmann said. “That’s why it’s so important that providers also have public health departments on their radar so they can track treatment failures.”
“In order to prevent resistance,” said Bachmann, “it’s really important to identify gonorrhea quickly and treat it appropriately with the right drug at the right time and in the right amount. This requires providers to adhere to guidelines for screening and appropriate treatment.”
The Massachusetts Department of Health requires providers to treat gonorrhea with high-dose ceftriaxone, conduct cultures from symptomatic gonorrhea cases and follow protocols for submitting specimens to the state laboratory, and test to ensure patients are cured after treatment. In addition, regular screenings are recommended for sexually active women age 24 and younger, women at increased risk, and sexually active men who have sex with men.
As for what individuals can do, Public Health Commissioner Margret Cooke offered the following advice in a statement: “We urge all sexually active people to get tested regularly for sexually transmitted infections and to consider reducing the number of sexual partners and increasing condom use. during sex.”