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Thursday, June 7, 2012

Health News: Drug-Resistant Gonorrhea

Drug-Resistant Gonorrhea Spreading Worldwide, WHO Warns

Officials at the World Health Organization (WHO) are urging governments and doctors to increase surveillance of potentially untreatable strains of drug-resistant gonorrhea and are calling for more vigilance on the proper treatment of the disease with antibiotics.
The widely spreading “superbug” strains of the sexually transmitted infection are resistant to cephalosporin antibiotics, normally the last line of defense against gonorrhea. Last year scientists reported finding a strain of gonorrhea in Japan in 2008 that was resistant to all recommended antibiotics; at the time, the researchers warned that it could turn the disease into a serious global health.
Gonorrhea Bacterium

Now, WHO reports that drug-resistant strains are popping up in many more countries, including Australia, France, Norway, Sweden and the U.K. Unless doctors catch and treat cases earlier, millions of people may run out of treatment options.
"This organism has basically been developing resistance against every medication we’ve thrown at it,” Dr. Manjula Lusti-Narasimhan, a scientist in the WHO’s department of sexually transmitted diseases, told the Associated Press. ”In a couple of years it will have become resistant to every treatment option we have available now.”
After chlamydia, gonorrhea is the most commonly sexually transmitted disease in the world, infecting more than 106 million people each year. In the U.S. alone, more than 700,000 people are estimated to become infected gonorrhea each year, and less than half of these cases are reported, according to the Centers for Disease Control and Prevention. In 2010, 309,341 cases of gonorrhea were reported to the CDC.
In an official WHO statement, Lusti-Narasimhan warned that without adequate surveillance, the true extent of the spread of drug-resistant gonorrhea remains unknown, and without new research into new antimicrobial agents, there could soon be no effective treatment left for those infected.

Untreated, the bacterial infection can cause:

  • infection of the urethra, cervix and rectum
  • infertility in both men and women
  • a significantly increased risk of HIV infection and transmission
  • ectopic pregnancy, spontaneous abortion, stillbirth and premature birth
  • severe eye infections that can lead to blindness, which occur in 30% to 50% of babies born to women with untreated gonorrhoea
Gonorrhea has already developed resistance to most common antibiotic treatments such as penicillin, tetracyclines and quinolones, driven by the improper or overuse of these medications. Over-the-counter availability of low-potency antibiotics in some Asian countries may also help explain why resistance is increasing.
Gonorrhea bacteria are also remarkably adaptable, quickly mutating and spreading its ability to resist antibiotics. Gonorrhea also tends to retain genetic resistance to previous antibiotics even after they are discontinued, the WHO says.
To prevent spread, better sex education is needed, along with increased monitoring and research into new treatments. Using condoms during sex is one of the most effective ways ti prevent infection. ”We’re not going to be able to get rid of it completely,” Lusti-Narasimhan told the AP. “But we can limit the spread.
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Causes, Incidence, and Risk Factors

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Anyone who has any type of sex can catch gonorrhea. The infection can be spread by contact with the mouth, vagina, penis, or anus.
The bacteria grow in warm, moist areas of the body, including the tube that carries urine out of the body (urethra). In women, the bacteria may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). The bacteria can even grow in the eyes.
Health care providers in every state in the U.S. are required by law to tell their State Board of Health about anyone diagnosed with gonorrhea. The goal of this law is make sure the patient gets proper follow-up care and that their sexual partners are found and tested.
You are more likely to develop this infection if you:
  • Have multiple sexual partners
  • Have a partner with a past history of any sexually transmitted infection
  • Do not use a condom during sex
  • Abuse alcohol or illegal substances


Symptoms of gonorrhea usually appear 2 - 5 days after infection, however, in men, symptoms may take up to a month to appear. Some people do not have symptoms. They may be completely unaware that they have caught the infection, and therefore do not seek treatment. This increases the risk of complications and the chances of passing the infection on to another person.
Symptoms in men include:
  • Burning and pain while urinating
  • Increased urinary frequency or urgency
  • Discharge from the penis (white, yellow, or green in color)
  • Red or swollen opening of penis (urethra)
  • Tender or swollen testicles
  • Sore throat (gonococcal pharyngitis)
Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:
  • Vaginal discharge
  • Burning and pain while urinating
  • Increased urination
  • Sore throat
  • Painful sexual intercourse
  • Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)
  • Fever (if the infection spreads to the fallopian tubes and stomach area)
If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur.

Signs and Tests

Gonorrhea can be quickly identified by staining a sample of tissue or discharge and then looking at it under a microscope. This is called a gram stain. Although this method is fast, it is not the most certain.
Gram stain tests used to diagnose gonorrhea include:
  • Cervical gram stain in women
  • Gram stain of urethral discharge in men
  • Joint fluid gram stain
Cultures (cells that grow in a lab dish) provide absolute proof of infection. Generally, samples for a culture are taken from the cervix, vagina, urethra, anus, or throat. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.
Cultures used to diagnose gonorrhea include:
  • Endocervical culture in women
  • Urethral discharge culture in men
  • Throat swab culture in both men and women
  • Rectal culture in both men and women
  • Culture of joint fluid
  • Blood cultures
DNA tests are especially useful as a screening test. They included the ligase chain reaction (LCR) test. DNA tests are quicker than cultures. Such tests can be performed on urine samples, which are a lot easier to collect than samples from the genital area.
If you have gonorrhea, you should ask to be tested for other sexually transmitted infections, including chlamydia, syphilis, and HIV. If you are 21 or older, you should be sure you have had a recent pap smear.


There are two goals in treating a sexually transmitted disease, especially one as easily spread as gonorrhea. The first is to cure the infection in the patient. The second is to locate and test all of the other people the person had sexual contact with and treat them to prevent further spread of the disease.
Never treat yourself without being seen by your doctor first. Your health care provider will determine the best and most up-to-date treatment.
About half of the women with gonorrhea are also infected with chlamydia, another very common sexually transmitted infection. Chlamydia is treated at the same time as a gonorrhea infection.
You should receive the hepatitis B vaccine. If you are younger than 26, you also need the HPV vaccine.
A follow-up visit 7 days after treatment is important if joint pain, skin rash, or more severe pelvic or belly pain is present. Tests will be done to make sure the infection is gone.
All sexual contacts of the person with gonorrhea should be contacted and tested. This helps prevent further spread of the disease. In some places you may be able to take counseling information and medicines to your sexual partner yourself. In other places, the health department will contact your partner.

Expectations (Prognosis)

A gonorrhea infection that has not spread to the bloodstream or other areas almost always can be cured with antibiotics. Gonorrhea that has spread is a more serious infection but almost always gets better with treatment.


Complications in women may include:
  • Salpingitis (scarring of the fallopian tubes), which can lead to problems getting pregnant or ectopic pregnancy
  • Pelvic inflammatory disease
  • Infertility (inability to become pregnant)
  • Pregnant women with severe gonorrhea may pass the disease to their baby while in the womb or during delivery
Complications in men may include:
  • Scarring or narrowing of the urethra, the tube that carries urine out of the body (See: Urethral stricture)
  • Abscess (collection of pus around the urethra)
Complications in both men and women may include:
  • Joint infections
  • Heart valve infection
  • Meningitis.


Not having sexual intercourse (abstinence) is the only absolute method of preventing gonorrhea. A monogamous sexual relationship with an individual known to be free of any STD can reduce risk. Monogamous means you and your partner do not have sex with any other persons.
You can greatly lower your risk of catching an STD by using a condom every time you have sex. Condoms are available for both men and women, but are most commonly worn by the man. A condom must be used properly every time. (For instructions on how to use a condom, see safe sex.)
To further prevent the spread of infection, treatment of all sexual partners is important.

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