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Gonorrhea Increasingly Resistant To Antibiotics

ATLANTA, Georgia (Reuters) -- Gonorrhea, the nation's No. 2 sexually transmitted disease, is showing increased resistance to the antibiotics commonly used to treat it, federal health officials said on Thursday.

The Centers for Disease Control and Prevention (CDC) said the drug-resistant strains are making it more difficult to successfully treat gonorrhea. More than 360,000 cases of the disease were reported last year.

"We're very concerned," said Dr. Chris Iverson, a CDC epidemiologist.

"We lost in the 1980s the ability to treat gonorrhea with penicillin and tetracycline. We now are seeing development of resistance to two newer antibiotics, limiting our options," he added.

A CDC-sponsored surveillance system has detected the first known cases of gonorrhea resistant to azithromycin, a commonly used antibiotic. A dozen cases were reported in Kansas City, Missouri, last year.

In addition, cases of fluoroquinolone-resistant gonorrhea, commonplace in Asia and the Pacific Islands, have risen sharply in Hawaii since 1997, the CDC said.

Two fluoroquinolone antibiotics -- ciprofloxacin and ofloxacin -- have been recommended by the CDC for treating gonorrhea since 1989. The drugs are preferred because they are inexpensive and can be given orally in a single dose.

In Hawaii, 1.4 percent of gonorrhea strains tested in the laboratory in 1997 were resistant to fluoroquinolones. By 1999, the prevalence had risen to 9.5 percent. In the Philippines, the resistance rate is as high as 70 percent, Iverson said.

Because of the increase, the CDC recommended that health-care providers ask patients with gonorrhea if they or their sex partners could have acquired the disease in Hawaii, Asia or Pacific islands.

If so, they should be treated with cefixime or ceftriazone, drugs for which no gonorrhea resistance has been reported in the United States, the CDC said.

Gonorrhea is the nation's second most-common sexually transmitted disease, after chlamydia, which infects an estimated 3 million people a year.

Gonorrhea can cause pelvic inflammation and infertility in women and can also facilitate the transmission of HIV, the virus that causes AIDS.

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CDC Recommends New Antibiotics For Gonorrhea

Mar. 23 --

THURSDAY, April 12 (HealthDay News) -- Newer antibiotics called cephalosporins should become the sole drug treatment for the sexually transmitted disease gonorrhea.

The reason: The bacterial infection is becoming increasingly resistant to treatment with the standard family of antibiotics called fluoroquinolones that includes Cipro, the U.S. Centers for Disease Control and Prevention said Thursday.

Since the early 1990s, fluoroquinolones have been the standard treatment for gonorrhea.

An article published in Friday's edition of the CDC's Morbidity and Mortality Weekly Report says that preliminary 2006 data show that fluoroquinolone-resistant gonorrhea is now widespread among both heterosexual and gay men in the United States.

A survey of 26 cities found that fluoroquinolone-resistant disease accounted for 6.7 percent of gonorrhea cases among heterosexual men, compared with about 0.6 percent of cases in 2001. Among gay men, drug-resistant strains accounted for 38 percent of gonorrhea cases in the first half of 2006.

The recognized threshold for changing treatment recommendations is when 5 percent of cases are drug-resistant, the CDC said.

Along with switching to cephalosporins to treat gonorrhea, the CDC recommends increased monitoring for cephalosporin-resistant gonorrhea and accelerated research into new treatments for the disease.

"Gonorrhea has now joined the list of other superbugs for which treatment options have become dangerously few. To make a bad problem even worse, we're also seeing a decline in the development of new antibiotics to treat these infections," Dr. Henry Masur, president of the Infectious Disease Society of America, told the Associated Press.

According to the U.S. National Institutes of Health, gonorrhea is the second most commonly reported bacterial sexually transmitted infection in the United States, following chlamydia. In 2004, there were 330,132 gonorrhea cases reported to the CDC. The highest rates of gonorrhea are found in African-Americans, 15 to 24 years of age, and women, the NIH said.

Gonorrhea can spread into the uterus and fallopian tubes, resulting in pelvic inflammatory disease (PID). PID affects more than 1 million American women every year and can cause tubal (ectopic) pregnancy and infertility in as many as 10 percent of infected women. Some researchers also think gonorrhea adds to the risk of HIV infection, according to the NIH.

More information

The U.S. National Institute of Allergy and Infectious Diseases has more about gonorrhea.

SOURCE: U.S. Centers for Disease Control and Prevention, news release, April 12, 2007

What's The Difference Between Chlamydia And Gonorrhea?

People of any anatomy can contract chlamydia or gonorrhea and never develop any symptoms. When symptoms do occur, there are a few telltale signs differentiating the two conditions.

Chlamydia and gonorrhea are both sexually transmitted infections (STIs) caused by bacteria. They can be contracted through oral, genital, or anal sex.

The symptoms of these two STIs overlap, so if you have one of these conditions, it's sometimes hard to be sure which one it is without having a diagnostic test at a doctor's office.

Some people with chlamydia or gonorrhea may have no symptoms. But when symptoms occur, there are some similarities, such as an abnormal, bad-smelling discharge from the penis or vagina, or a burning feeling when you pee.

Chlamydia is more common than gonorrhea. According to a 2017 report, over 1.7 million cases of chlamydia were reported in the United States, while just over 550,000 cases of gonorrhea were documented.

Read on to learn about how these two STIs are different, how they're similar, and how you can reduce your risk for these infections.

People of any anatomy can contract chlamydia or gonorrhea and never develop any symptoms.

With chlamydia, symptoms may not appear for a few weeks after you've contracted the infection. And with gonorrhea, people who have female anatomy may never experience any symptoms at all or may only show mild symptoms, while people who have male anatomy are more likely to have symptoms that are more severe.

A couple of the most telltale symptoms of these STIs overlap between the two, such as:

burning when you pee

abnormal, discolored discharge from the penis or vagina

abnormal discharge from the rectum

pain in the rectum

bleeding from the rectum

With both gonorrhea and chlamydia, people with male anatomy may also experience abnormal swelling in their testicles and scrotum, and pain when they ejaculate.

You may also develop symptoms that affect your throat if you engage in oral sex with someone who has one of these conditions. This can cause mouth and throat symptoms, including sore throat and a cough.

Chlamydia symptoms

With chlamydia, people with female anatomy may experience more severe symptoms if the infection moves upward to the uterus and fallopian tubes. This can cause pelvic inflammatory disease (PID).

PID can cause symptoms such as:

fever

feeling sick

vaginal bleeding, even if you're not having a period

intense pain in your pelvic area

Seek emergency medical help if you think you may have PID.

Gonorrhea symptoms

With gonorrhea, you may also notice rectal symptoms like itching, soreness, and pain when you defecate.

People with female anatomy may also notice heavier bleeding during their periods and pain during sex.

Both conditions are caused by an overgrowth of bacteria. Chlamydia is caused by an overgrowth of the bacteria Chlamydia trachomatis.

Gonorrhea is caused by an overgrowth of bacteria called Neisseria gonorrhoeae.

Both STIs are caused by bacterial infections that are transmitted through unprotected sexual contact, meaning sex without using a condom, dental dam, or another protective barrier between you and your partner during vaginal, anal, or oral sex.

It's also possible to contract the infection through sexual contact that doesn't involve penetration. For example, if your genitals come into contact with the genitals of someone who's contracted the infection, it's possible to develop the condition.

Both STIs can also be contracted through protected sex with a condom or other barrier if you don't use protection properly, or if the barrier breaks.

Either STI can be contracted even if you aren't showing visible symptoms. Both STIs can also be transmitted to a child at birth if the mother has either condition.

You're at increased risk for developing these and other STIs if you:

have multiple sexual partners at one time

don't properly use protection, such as condoms, female condoms, or dental dams

regularly use douches which can irritate your vagina, killing healthy vaginal bacteria

have contracted an STI before

Sexual assault can also increase your risk of both chlamydia or gonorrhea.

Get tested for STIs as soon as possible if you've recently been forced to have non-consensual oral, genital, or anal sex. If you're in the United States, you can also call the Rape, Abuse, and Incest National Network (RAINN) for support from people who can help without revealing any of your personal information or details of your experience.

Both STIs can be diagnosed using similar diagnostic methods. Your doctor may use one or more of these tests to ensure that the diagnosis is accurate and that the right treatment is given:

physical examination to look for symptoms of an STI and determine your overall health

urine test to test your urine for the bacteria that cause chlamydia or gonorrhea

blood test to test for signs of bacterial infection

swab culture to take a sample of discharge from your penis, vagina, or anus to test for signs of infection

Both STIs are curable and can be treated with antibiotics, but you're more likely to contract the infection again if you've had either STI before.

Treatment for chlamydia

Chlamydia is usually treated with a dose of azithromycin (Zithromax, Z-Pak) taken either all at once or over a period of a week or so (typically about five days).

Chlamydia can also be treated with doxycycline (Oracea, Monodox). This antibiotic is usually given as a twice-daily oral tablet that you need to take for about a week.

Follow your doctor's dosage instructions carefully. It's important to take the full dosage for the prescribed number of days so that the antibiotics can clear the infection. Not completing the round of antibiotics can cause you to become resistant to that antibiotic. This can be dangerous if you contract the infection again.

If you're experiencing symptoms, they should begin to fade a few days after you start treatment.

Avoid sex until your doctor tells you that the infection has fully been cleared by the antibiotics. It can take two weeks or more for the infection to clear up, and during that time, you can still transmit the infection.

Treatment for gonorrhea

Your doctor will likely prescribe ceftriaxone (Rocephin) in the form of an injection into your buttock.

The CDC previously recommended ceftriaxone plus azithromycin, but the guidelines were changed because the bacteria causing gonorrhea are becoming increasingly resistant to azithromycin.

Using both antibiotics helps clear the infection better than using only one treatment alone.

As with chlamydia, don't have sex until the infection clears, and be sure to take your entire dose.

Gonorrhea is more likely than chlamydia to become resistant to antibiotics. If you contract the infection with a resistant strain, you'll need treatment with alternative antibiotics, which your doctor will recommend.

Some complications of these STIs can happen to anyone. Others are unique to each sex due to differences in sexual anatomy.

Gonorrhea has more severe possible complications and is more likely to cause long-term problems like infertility.

In both males and females

Complications that may be seen in anyone include:

Other STIs. Chlamydia and gonorrhea both make you more susceptible to other STIs, including human immunodeficiency virus (HIV). Having chlamydia can also increase your risk of developing gonorrhea, and vice versa.

Reactive arthritis (chlamydia only). Also called Reiter's syndrome, this condition results from an infection in your urinary tract (your urethra, bladder, kidneys, and ureters — the tubes that connect the kidneys to your bladder) or intestines. Symptoms of this condition cause pain, swelling, or tightness in your joints and eyes, and a variety of other symptoms.

Infertility. Damage to reproductive organs or to sperm can make it more challenging or, in some cases, impossible to become pregnant or to impregnate your partner.

In males

Testicular infection (epididymitis). Chlamydia or gonorrhea bacteria can spread to the tubes next to each of your testicles, resulting in infection and inflammation of testicle tissue. This can make your testicles swollen or painful.

Prostate gland infection (prostatitis). Bacteria from both STIs can spread to your prostate gland, which adds fluid to your semen when you ejaculate. This can make ejaculation or peeing painful, and cause fevers or pain in your lower back.

In females

Pelvic inflammatory disease (PID). PID happens when your uterus or fallopian tubes contain an infection from the bacteria. PID requires immediate medical attention in order to prevent damage to your reproductive organs.

Infections in newborns. Both STIs can be transmitted to a baby during birth from vaginal tissue that contains an infection from the bacteria. This can result in complications like eye infections or pneumonia.

Ectopic pregnancy. These STIs can cause a fertilized egg to become attached to tissue outside the uterus. This type of pregnancy won't last until birth and can also threaten the mother's life and future fertility if it's not treated.

The only way that you can completely prevent yourself from catching chlamydia, gonorrhea, or another STI is by abstaining from sexual activity.

But there are also plenty of ways you can reduce your risk of contracting or transmitting these infections:

Use protection. Both male and female condoms are effective in helping to reduce your risk from infection by either bacteria. Using proper protection during oral or anal sex can also reduce your risk of infection.

Limit your sexual partners. The more sex partners you have, the more you risk exposing yourself to an infection. And because these STIs may not cause noticeable symptoms, sex partners may not know they have the condition.

Get regularly tested. Whether you're having sex with multiple people or not, regular STI tests can help you remain aware of your sexual health and ensure that you're not unknowingly transmitting an infection to others. Regular testing can also help you identify an infection even if you're not experiencing any symptoms.

Don't use products that affect your vaginal bacteria. Healthy bacteria in the vagina (called vaginal flora) helps fight off infections. Using products like douches or scented odor-reduction products can upset the balance of vaginal flora and make you more susceptible to infection.

Both chlamydia and gonorrhea can be transmitted in the same ways, and both can easily be treated using antibiotics.

Both are also preventable if you take precautions during sex, such as using protection and limiting the number of people you have unsafe sex with at any given time.

Regular STI testing, for both you and your sexual partners, can also help reduce the risk of transmitting an infection if you or a sexual partner develop an STI.

If you suspect an STI or have been diagnosed with one, stop all sexual activity and get treatment as soon as possible. If you're diagnosed, tell anyone you've had sex with to get tested just in case.

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