Super gonorrhea: bad bugs, no drugs

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Capital News Service
LANSING—Health experts are bracing for a strain of gonorrhea resistant to all forms of antibiotic treatment, a threat potentially more daunting than HIV AIDS.
While the Centers for Disease Control and Prevention (CDC) say that it is still too early to determine whether this strain has become widespread, Michigan communities are playing it safe.
“We’re not waiting until it becomes a problem to start talking about it,” said Meghan Swain, executive director of the Michigan Association for Local Public Health.
The main focus of health departments’ efforts right now is prevention.
“I’m not aware of any recent spikes in gonorrhea,” said Kate Donaldson, public information officer for the Local Health Department for District 10, which serves Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana and Wexford counties.
“Educating the public and raising awareness among doctors is one approach adopted by local health departments and global institutions, such as the United Nations World Health Organization,” said Kara Schrader, doctor of nursing practice and family nurse practitioner for the College of Nursing at Michigan State University.
Doctors are urged by the CDC and the Michigan Department of Health and Human Services to be on the lookout for gonorrhea resistant to medicines now used to treat the disease and report cases immediately, Donaldson said.
Those medicines include cephalosporins that are antibiotics derived from the mold Cephalosporium. They are used because penicillin is no longer effective in treating the disease. But they are ineffective against the new strain.
“At this point, gonorrhea is basically resistant to penicillin,” Donaldson said. “There used to be four antibiotics for effective treatment. Now we’re down to one.”
While gonorrhea is not a virus and cannot be vaccinated against, its future is so dismal for successful treatment options that it could be the next generation’s equivalent to HIV AIDS.
Gonorrhea is more of a problem in southern parts of the state.
“Right now, we’re not concerned about resistance patterns locally,” said Joshua Meyerson, medical director for the Health Department of Northwest Michigan, Benzie-Leelanau Health Department and District Health Department 4, serving Alpena, Cheboygan, Montmorency and Presque Isle counties.
But that could easily change.
“Today’s shrinking world makes drug-resistant strains just a plane ride away,” Meyerson said. “Gonorrhea has shown increasing resistance over the past 10 years, so we’ve previously implemented ‘dual treatments’ in the hope of decreasing the risk of emerging strains.”
However, dual therapy might be part of the problem, as the Center for Disease Control no longer recommends treating gonorrhea with both cephalosporin and another drug, either azithromycin or doxycycline.
According to Schrader, this concern about gonorrhea is an extension of a greater concern for overprescribing antibiotics for many bacterial illnesses, including pneumonia, urinary tract infections and skin infections. Since 2010, the medical profession has been told to stop prescribing now ineffective antibiotics, such as cefixime and azithromycin, she said.
A report released this past summer by the CDC confirms what experts already know: cephalosporin resistance would significantly complicate– and potentially eliminate– health professionals’ ability to effectively treat gonorrhea.
“Healthcare providers are aware of this resistance problem,” she said, “but it seems that we need to educate the public in antibiotics.”
Local health departments are staying informed by attending state-sponsored conferences and keeping an eye on health alerts from the CDCl, Swain said.
“It’s important that the public knows they have access to confidential and free testing,” Meyerson said. Prevention is ideal, but resources are there to help when the unexpected happens.
While eventual resistance seems inevitable, local health departments report cases of gonorrhea, helping larger national and international organizations to encourage research and development for new treatments.

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