Changing face of gonorrhoea

New drug-resistant strains of gonorrhoea are popping up from Massachusetts to Hawaii, raising the possibility that doctors will have to radically change their approach to a disease that strikes an estimated 650 000 Americans each year.

If the strains become more common, sexually transmitted disease clinics may have to return to the days when gonorrhoea patients needed injections instead of single doses of oral antibiotics such as Cipro.

Such a scenario would create significant inconvenience and increase costs in the systems and risks [from needle sticks] to health-care personnel, says Dr David Martin, director of the Louisiana STD Research Center and chief of the infectious diseases division at the Louisiana State University Medical Center.

Gonorrhoea
Gonorrhoea is one of the most common sexually transmitted diseases, perhaps best known for its symptoms in men of burning and discharge from the penis. While its symptoms may be less noticeable in women, gonorrhoea can hit them harder by causing pelvic inflammatory disease. In both sexes, untreated gonorrhoea can spread infection to the blood and joints, in addition to making HIV easier to transmit.

Doctors have considered Cipro and its sister drugs to be the best treatments for gonorrhoea. But then the disease began to mutate into new forms that are immune to the drugs.

Cipro-resistant gonorrhoea

The first cases of Cipro-resistant gonorrhoea appeared in Hawaii, Asia and islands in the Pacific as early as 2000, according to the US Centers for Disease Control and Prevention (CDC). The strains, which are immune to Cipro and its sister drugs, subsequently spread to California.

In a new report, the CDC announced that drug-resistant strains have begun appearing elsewhere in the United States. In late 2002 and early this year, researchers noticed the strains showed up in patients who had not visited Hawaii, California or Asia, where they could have been infected or had sex with partners who had.

Patients can turn to injections
The CDC is warning the strains have appeared in New York City, Washington state, Massachusetts, Michigan and Indiana. Officials are advising doctors in Hawaii, California, Massachusetts and parts of Michigan to stop or monitor their use of Cipro and its sister drugs, known as fluoroquinolones.

Instead of taking Cipro in pill form, patients can turn to injections of a drug known as ceftriaxone (marketed in South Africa as Oframax Injection, Pharmacare-Ceftriaxone Injection and Rocephin Injection). But injections are dangerous for nurses because gonorrhoea patients are often infected with blood-borne diseases such as HIV and hepatitis B and C, Martin says.

The problem with injections
Also, it takes more time for nurses to give injections than simply hand out pills, he says: In a busy clinic, it would limit the number of patients who could be seen in a day.

A return to injections would also make it impossible for doctors to send patients home with pills for their infected partners, who might otherwise never come to a clinic, says Dr Thomas Farley, chairman of the Department of Community Health Sciences at Tulane University School of Public Health and Tropical Medicine. It won't ruin gonorrhoea efforts, but it would make them a lot more difficult.

Not the end of the world
The good news is the injection drug ceftriaxone will still quickly and effectively kill the disease in patients, Martin says. It's not like the end of the world in terms of not having anything to treat gonorrhoea.

In fact, doctors have plenty of experience in coping with the changing face of gonorrhoea. In the 1970s and 1980s, strains of the infection became immune to the antibiotic penicillin, and doctors had to search for alternatives.

In 1988, doctors turned to two oral drugs - Cipro and cefixime, a drug known by the brand name Suprax. Patients no longer had to get two injections of penicillin in the buttocks or take more than a week's worth of pills.

Patients could treat themselves
These drugs made it possible for nurses in clinics to treat patients on the spot, without injections, and make sure they got effective treatment, rather than relying on the patients to take (or often, forget to take) seven to 10 days of pills, Farley says.

But the manufacturer of Suprax no longer makes the drug. And the disease itself may be taking Cipro out of the picture. – (HealthDayNews)

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