10 Essential Facts About Chlamydia

what antibiotics treat syphilis and gonorrhea :: Article Creator

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.

Super Gonorrhea May Be Spreading From Antibiotic Overuse For Covid-19 Coronavirus

Will the Covid-19 coronavirus lead to much wider spread of drug-resistant gonorrhea in 2021? (Photo ... [+] credit should read FREDERIC J. BROWN/AFP via Getty Images)

AFP via Getty Images

You want 2021 to be super. But not in a super gonorrhea type of way.

"Super gonorrhea" is trending on Twitter right now because, well, why not? It's 2020, after all. And what better thing to have trend at the end of a year that brought us the Covid-19 coronavirus pandemic, a shortage of basically everything, constant drama in the White House, and a Presidential election that just won't end? Consider this sexually transmitted infection to be the pie à la mode, the night cap, the final wipe of 2020.

If you haven't figured it out yet, super gonorrhea is not super to have. It won't prompt you to tell your partner, "I just returned from the doctor's office, and I've got super news for you." Nah, telling him or her that you have super gonorrhea would be about as positive as saying that you have sexy syphilis or candy-coated chlamydia. Super gonorrhea isn't a comic book hero either, in case you are wondering:

If it were featured in a film, super gonorrhea would give Ghost Rider a run for worst comic book movie ever.

Instead, super gonorrhea results when the bacteria that causes gonorrhea, Neisseria gonorrhoeae, develops a high level of resistance to the antibiotics normally used to treat the infection: azithromycin and ceftriaxone. As I reported back in 2017 for Forbes, the World Health Organization (WHO) listed such strains of N. Gonorrhoeae on its world's most dangerous superbugs list. When making your bucket list, don't include anything on this WHO superbug list. "We've run out of ways to treat your infection," ranks up there with "no one can fly the airplane" or "the hull of the cruise ship that you are on is made out of pickles" on the list of things that you don't want to hear.

Then in 2018, I covered for Forbes a case of a man from the United Kingdom (U.K.) who had had a "super" sexual encounter while traveling in Southeast Asia. The man developed symptoms a month later and was diagnosed with super gonorrhea. As a result, the man's regular partner in the U.K. Had to get tested, but she fortunately tested negative for the superbug. It's not clear whether this couple remained together after the super revelation. After all, things like not knowing how to tango or infecting you with super gonorrhea can be deal breakers for some when it comes to dating. If the relationship did continue, the woman would have had quite a card to raise in future arguments such as, "what you won't take out the trash? Well, remember that time you had sex with someone else and almost gave me super gonorrhea?"

So why is super gonorrhea trending on Twitter when there are oh so many other things that can trend? Well, there are different possibilities:

But it looks like the trending stemmed from a WHO spokesperson telling The Sun that the overuse of azithromycin and the lack of services to treat sexually transmitted infections (STIs) during the Covid-19 coronavirus pandemic may be fueling the rise of super gonorrhea. Not the Sun as in that fiery ball in the sky that you shouldn't look at even during an eclipse but The Sun as in the U.K. Publication.

Indeed, use azithromycin more often can select for more resistant versions of N. Gonorrhoeae. Remember earlier this year when some were touting the use azithromycin along with hydroxychloroquine to treat Covid-19? And some political leaders jumped on this bandwagon? This was even before well-constructed and executed clinical studies were done to assess the safety and efficacy of such medications for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections. So this was an example of premature medication. Since then clinical studies have not found enough evidence to support such use. In a commentary in The Lancet, Catherine E. Oldenburg, PhD, an Assistant Professor and Thuy Doan, MD, PhD, an Associate Professor at the University of California, San Francisco, (UCSF) concluded "for patients with Covid-19, the addition of azithromycin to existing standard of care regimens does not appear to improve outcomes," after reviewing results from the COALITION II trial that evaluated adding azithromycin to hydroxychloroquine and standard of care to treat patients hospitalized with severe Covid-19.

As a result of the scientific evidence that has subsequently emerged, the National Institutes of Health (NIH) Covid-19 Treatment Guidelines Panel now "recommends against the use of chloroquine or hydroxychloroquine with or without azithromycin for the treatment of Covid-19" in hospitalized or non-hospitalized patients.

A worker is engaged in producing the Azithromycin antibiotic at the Biokhimik [Biochemist] ... [+] pharmaceutical company. Azithromycin was registered by the Russian Healthcare Ministry on June 23, 2020, and included in the guidelines for the treatment of COVID-19 patients. (Photo by Artyom Geodakyan\TASS via Getty Images)

Artyom Geodakyan/TASS

For everyone who may have said, "what's the harm in continuing to use azithromycin to treat SARS-CoV2 infections," well here's a super response. Using antibiotics indiscriminately on infectious diseases as if the medications were Nutella can encourage the growth of resistant organisms. Antibiotics like azithromycin are considered "broad spectrum" because they can kill or inactivate a wide range of different bacteria. It's like using a bomb rather than a rifle. That can be helpful when you don't know what is causing an infection or when there is no other option.

However, every time you use a broad spectrum antibiotic rather than a treatment that's a lot more targeted and specific, you risk wiping out friendlier bacteria and weaker versions of a pathogen like N. Gonorrhoeae, leaving stronger more resistant versions a more open field to flourish. The remaining stronger ones then multiply and become a lot more predominant. This is how more resistant versions of the bacteria take over and spread.

In the U.S., the five years from 2013 to 2018 saw an over sevenfold jump in the percentage of N. Gonorrhoeae samples that are less susceptible to azithromycin from 0.6% to 4.6%. The rise of azithromycin resistance in N. Gonorrhoeae has prompted a December 18 change in the Centers for Disease Control and Prevention (CDC) guidelines for treating uncomplicated gonorrhea. Rather than a two-drug azithromycin and ceftriaxone approach, the CDC is now recommending just one 500 mg injection of ceftriaxone. By "uncomplicated," the CDC means your run-of-the-mill gonorrhea infections of number one your urinary tract, number two your rectum, your genital areas, or your throat. If you don't know how each of these places can be affected by N. Gonorrhoeae, you may need to re-take sex ed. Of course, more complicated gonorrhea may require antibiotics.

One problem with the Covid-19 coronavirus pandemic is that other pathogens haven't necessarily taken a break. They haven't spent most of their time on Zoom calls muting each other and using the video filters while saying, "hey look at me, herpes with a hat." While humans social distancing may have limited the spread of some pathogens such as influenza, others may have had a good 2020.

The Covid-19 coronavirus pandemic has either closed or limited the efforts of clinics and other ... [+] efforts that normally aim to reduce the spread of sexually transmitted infections. (Photo by Derek Davis/Portland Portland Press Herald via Getty Images)

Portland Press Herald via Getty Images

After all, the pandemic has not only prompted doctors to try different antibiotics to treat Covid-19 coronavirus, it has also reduced the availability of doctors to properly treat STIs. The pandemic has shut down many "non-essential" health services or dissuaded many patients from seeking proper medical care. Therefore, people may be running around with untreated infections or trying to self-treat with potentially inappropriate antibiotics.

As I've said repeatedly, the Covid-19 coronavirus pandemic has been exposing many of the problems that have already existed in society. Antibiotic-resistant bacteria is one of them. If nothing is done to better tackle this looming problem, pathogens like super gonorrhea will be far from gone baby gone in 2021 and beyond.

Full coverage and live updates on the Coronavirus

Physician Group Calls For Increased Syphilis Screening For Pregnant Women

The American College of Obstetricians and Gynecologists (ACOG) is recommending that all pregnant individuals be screened for syphilis three times during pregnancy. The recommendation comes as cases of newborns with syphilis has spiked in recent years. In it's practice advisory, ACOG calls for three screenings, once at the first prenatal care visit and again in the third trimester and again at birth.

A recent report from the Centers for Disease Control and Prevention that looks at sexually transmitted infections shows while cases of other STIs, like chlamydia and gonorrhea, have decreased or seen modest increases, syphilis has jumped 80% in the four years from 2018 to 2022.

"There has been a near eightfold increase in congenital syphilis cases in the last decade or more, and from a public health perspective, we recognize that obstetrician-gynecologists and other obstetric care clinicians play a critical role," said Christopher Zahn, MD, FACOG, interim CEO and chief of clinical practice and health equity and quality. "While we continue to endorse CDC's sexually transmitted infection treatment guidelines, ACOG's new guidance will no longer follow an individualized risk-based approach to testing later in pregnancy and instead help ensure more opportunities for testing and treatment."

Dr. Stacey Rizza, a Mayo Clinic infectious diseases specialist, says syphilis is a bacterial infection that is primarily transmitted through sexual contact. But she says it also can be transmitted from an expecting mother to the baby.

"So if a mother has syphilis, whether she knows it or not, while she's pregnant and is not diagnosed and treated, she can transmit that to her fetus, and the baby can be born with syphilis," says Dr. Rizza. This is also known as congenital syphilis, and according to the CDC report, cases of syphilis among newborns rose 183% between 2018 and 2022.

Dr. Rizza says the baby may be born asymptomatic, "but can go on to develop manifestations of syphilis later, within weeks, months or even years, after they're born. But, unfortunately, many times it causes abnormalities in the baby, even when they're born. They can have abnormalities in their liver and their spleen, they can have rashes, they can have abnormality in the structure of their face, in the brain, and particularly involving the eye."

If you are expecting or have recently given birth, and you suspect you may be infected, Dr. Rizza encourages testing as soon as possible. "So we can treat them during the pregnancy and prevent them from transmitting to the baby. And if somebody is born with syphilis, whether they have manifestations of it or not, we want to make sure we diagnose it quickly and treat it, so they don't go on to have further manifestations," she says.

Diagnosis is made with a blood test. If positive, treatment with the antibiotic penicillin has proven effective.

___

What is HPV