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New Gonorrhea Cases In Hawaii Are A Warning Sign For The CDC

Further proof that we need more options for treating sexually transmitted infections.

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For the first time in the US, a cluster of gonorrhea cases showed increasing resistance to the current treatment method.

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These findings were presented today at the 2016 STD Prevention Conference held in Atlanta, GA.

Gonorrhea is a common, often symptomless sexually transmitted infection (STI). The current treatment method is a combination of two antibiotics: a shot of ceftriaxone and a prescription for azithromycin.

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That's the only treatment option known to be effective, since gonorrhea has already developed resistance to several other antibiotics.

In July, the CDC issued a report that there is an emerging resistance to azithromycin, possibly due to providers only prescribing one of the two medications.

And now, new cases of gonorrhea in Hawaii show decreased susceptibility to both ceftriaxone and azithromycin.

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The Hawaii State Department of Public Health has been taking cultures of gonorrhea infections when people are diagnosed, then growing an isolate of that infection in a lab, and testing that isolate against different antibiotics.

In April and May 2016, the lab identified gonorrhea isolates from seven patients that showed dramatically higher levels of resistance to azithromycin than we typically see in the US. And in five of the cases, the gonorrhea isolates also showed reduced susceptibility to ceftriaxone.

Basically, that means these isolates are less susceptible than ever to the current medications we have available.

It's important to note that these weren't actually drug-resistant cases of gonorrhea. All patients were cured with the current treatment method.

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But the fact that the gonorrhea isolates showed a higher resistance to the drugs than ever before is a harsh warning sign that our current meds may not work much longer.

Dr. Gail Bolan, director of CDC’s Division of STD Prevention, stressed that providers need to be vigilant about prescribing the proper treatment method, and patients need to actually finish those antibiotics. Even if your symptoms improve, you could still have the infection. That's why it's recommended to always get retested after treatment to confirm the infection is cleared.

Fortunately, a new drug is being tested with promising results.

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Also presented today at the 2016 STD Prevention Conference: a new drug that just finished its phase 2 trial.

The drug, ETX0914, is a single-dose oral medication with a different mechanism of action than our current gonorrhea treatment, said the trial's lead investigator Dr. Stephanie Taylor, professor of medicine and microbiology at Louisiana State. In the trial released today, the drug was tested in 179 participants in either 2g or 3g doses. All patients with the 3g dose and 98% of the patients with the 2g dose were cured.

That said, the drug will still need to continue through clinical trials before being considered as a possible treatment method. So for now, the gonorrhea treatment recommendations aren't changing, said Bolan.

FYI: Most people with gonorrhea actually don't know they have it.

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There were 350,000 US cases reported in 2014 (the most recent data from the CDC), mostly in people under 25. But it's estimated that the actual number of cases each year is around 800,000, since fewer than half of cases get diagnosed.

If left untreated, it can lead to pelvic inflammatory disease, scar tissue, chronic pain, and infertility in women; it can lead to inflammation of the tubes connected to the testicles in men, which could also lead to infertility.

Gonorrhea is transmitted through infected secretions or fluids, so it can be transmitted through vaginal, oral, or anal sex. So if you're having sex of any kind and aren't sure of your STI status or your partner's status, get tested.

And don't panic. Gonorrhea is still treatable — and curable — with the current medications.

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Just make sure to stick with those antibiotics and get your partner treated, too. And until the infection is cleared, use protection like condoms or dental dams.

You can find out more about STI testing and what you need to get tested for here.

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