You may have seen some of the headlines across the Internet a few weeks ago, but a paper published in the New England Journal of Medicine sounded the alarm regarding disturbing trends in gonorrhea resistance across the country. The paper was actually based on a report released a year ago. From 2000 to 2010, the CDC collected samples from patients with gonorrhea over the past decade and tested how well antibiotics worked on them. In July 2011, they released their findings, and reported some disturbing trends.What they found is that gonorrhea is showing increased resistance to our main weapon against it: a class of antibiotics called the cephalosporins. In this country, for treatment of gonorrhea, we use mainly two different medications out of this class: an oral tablet, and an injection. From 2000 to 2010, the overall rate of resistance to the oral tablet increased from 0.2% to 1.4%, and for the injection, resistance increased from 0.1% to 0.3%. This may not seem like a big increase at first, but these figures varied from region to region.
For example, resistance to the tablet is seen in up to 4.5% of samples in California (a 20 fold increase) and 7.7% of samples from Hawaii (an almost 40 fold increase) . And in general, these numbers get even higher in gay men. If you are a gay male living on the West coast (yes, that’s most of you reading this), any gonorrhea you acquire has a 1 in 20 chance of being completely resistant to one of our last best effective treatments, and it’s getting worse.
Further compounding our worry is that this was the exact trend seen with another antibiotic class called the fluoruquinolones - medications that were quite effective for gonorrhea in the 90s, then showed single digit resistance in Hawaii and the West Coast, and by the mid 2000s, were rendered useless.
Yikes.
But don’t fret - it’s not time to go celibate. The CDC report also noted that, despite some increased resistance, the injection treatment is still quite potent against most gonorrhea. And thankfully, a different oral antibiotic is also effective as well. In fact, the current recommended treatment is receiving both at the same time (a shot in the arm, and some pills you take as one dose). Synergy!
So here’s what this means for you. If you ever develop a sensation of burning with urination, or a urethral discharge, or painful mucousy stools, or a bad sore throat after a hookup, you should come see us in person. The “in person” part is for two reasons: we need to do confirmatory testing, and we need to consider treating you with the injection and the accompanying pills.
Well, threefold... we want to see your friendly face :)
--Vy X. Chu, MD
