First Antibiotic-Resistant Gonorrhea Cases Detected in North America
Completely incurable gonorrhea may be at hand
Gonorrhea infects close to 700,000 Americans each year.
The fears of major health organizations have come true: Gonorrhea that is immune to the last remaining effective oral antibiotic has been detected in at least nine North American patients, meaning the era of "incurable" gonorrhea could be close.
In a study released Tuesday in the
Journal of the American Medical Association, a group of scientists led by Vanessa Allen of Public Health Ontario, found that 6.7 percent of patients with gonorrhea at a Toronto clinic still had the disease after a round of cephalosporins, the last effective oral antibiotic used to treat the disease. Of 133 patients who returned for a "test of cure" visit, nine remained gonorrhea-positive. This is the first time cephalosporin-resistant gonorrhea has been found in humans in North America.
Last year, both the World Health Organization and the Centers for Disease Control warned that untreatable gonorrhea—the world's second most common sexually transmitted infection—could soon be a reality as the bacteria showed increasing resistance to cephalosporins in lab tests.
"These are the clinical cases we've been waiting for," Allen says. "This is the translation of the lab information into what the clinical consequence is."
Previously, there had been a couple individual case reports of untreatable gonorrhea cases in the United Kingdom, Austria, France, Norway, and Japan. In an accompanying editorial, Robert Kirkcaldy of the CDC writes that gonorrhea is quickly becoming a more threatening disease.
"Cephalosporin treatment failures have now been documented in North America," he writes. "Although this milestone was expected, its arrival is deeply troubling."
Gonorrhea is estimated to infect close to 700,000 Americans each year. Symptoms include painful urination, abdominal pain, genital discharge, itching, and infertility in women. Women who have both HIV and gonorrhea are more likely to pass HIV to their offspring than women with just HIV.
Less than a year ago, Gail Bolan, director of the CDC's sexually transmitted disease prevention program, wrote that the "threat of untreatable gonorrhea is emerging rapidly." At the time, just 1.7 percent of gonorrhea isolated in the lab were considered resistant to cephalosporins. Allen says her study shows just how fast antibiotic resistance is evolving in the organisms.
"Our results aren't generalizable to the overall population because they all came from one clinic," she says. "But basically, the problem appears worse than we originally thought."
Although each of the nine patients in Canada were cured with the injectable antibiotic known as ceftriaxone, Allen warns that there's been "a parallel increase" in resistance to that antibiotic.
"I think without a doubt this will become a bigger problem," Allen says. "The next threat is when, not if, the same thing happens with ceftriaxone. And then what?"
According to Kirkcaldy, "clinicians now face the emergence of cephalosporin-resistant [gonorrhea] without well-studied, effective backup treatment options."
Disease risks in China? - A surge in the dumping of dead pigs upstream from Shanghai – with more than 2,800 carcasses floating into the financial hub through Monday – has followed a police campaign to curb the illicit trade in sick pig parts. Authorities have been pulling out the swollen and rotting pigs, some with their internal organs visible, since Friday – and revolting images of the carcasses in news reports and online blogs have raised public ire against local officials. “Well, since there supposedly is no problem in drinking this water, please forward this message, if you agree, to ask Shanghai’s party secretary, mayor and water authority leaders if they will be the first ones to drink this meat soup?” lawyer Gan Yuanchun said on his verified microblog. On Monday, Shanghai officials said the number of dumped adult and piglet carcasses retrieved had reached 2,813. The city government, citing monitoring authorities, said the drinking water quality has not been affected. Shanghai’s Agriculture Committee said authorities don’t know what caused the pigs to die, but that they have detected a sometimes-fatal pig disease in at least one of the carcasses. The disease is associated with the porcine circovirus, which is widespread in pigs but doesn’t affect humans or other livestock. Shanghai’s city government said initial investigations had found the dead pigs had come from Jiaxing city in neighboring Zhejiang province. It said it had not found any major epidemic. Huang Beibei, a lifetime resident of Shanghai, was the first to expose the problem when he took photos of the carcasses and uploaded them onto his microblog on Thursday. “This is the water we are drinking,” Huang wrote. “What is the government doing to address this?” Huang said he’s most concerned about water safety. “Though the government says the water is safe, at least I do not believe it – given the number of the pigs in the river. These pigs have died from disease,” Huang said.
In China, pigs that have died from disease should be either incinerated or buried, but some unscrupulous farmers and animal control officials have sold problematic carcasses to slaughterhouses. The pork harvested from such carcasses has ended up in markets. The Shanghai government said today on its official Weibo microblog account that the total number of carcasses found in the Songjiang and Jinshan districts has risen to more than 2,800 as of yesterday, up from the more than 1,200 reported earlier. A preliminary investigation showed the dead pigs, which include piglets and mature hogs, had floated down the river from neighboring Zhejiang province, it said. Discovery of the dead pigs is the latest scare in China, where the government has come under criticism for its handling of health and environmental issues. The government announced yesterday a plan for a regulator with broader authority to ensure food and drug safety and said the agriculture ministry will oversee the quality of farm products, underpinning its pledge to crack down on violations and better protect consumers. –Bloomberg 
