Tag Archives: gonorrhea

The clap is making a comeback — as are syphilis and chlamydia

Syphilis, gonorrhea, and chlamydia are catching on with more and more people, says the Centers for Disease Control (CDC).

Image credits Paul Sableman / Flickr.

Rates of these sexually-transmitted diseases (STDs) are on the rise, the CDC warns in a recent report. Both the number of infections per capita and the total number of cases for all three STDs have been steadily rising since the 2000s. All in all, the report adds, infection rates are at their highest level since the CDC began keeping track of chlamydia cases in 1984.

A social endeavor

The CDC says that the increase isn’t automatically attributable to a bump in the number of infected individuals. As testing becomes more commonplace, each state naturally reports higher numbers of positive results. The observed increase, the CDC explains, can be caused by more states reporting on cases of these three STDs, or by them improving testing practices.

Still, the recent increases from year to year, when testing practices have not dramatically changed, likely indicate an increase in the number of infections themselves, the authors note.

For chlamydia, they report, increased testing and the refinement of testing methods (the report notes to the expanded use of “nucleic acid amplification tests” between 2000 and 2011 in particular) likely drive most of the observed increase in cases. This view is further reported by a separate CDC document that found no statistically significant increase in the chlamydia rate between 1999 and 2012.

That being said, the current report does note that the current prevalence of chlamydia is “surprising”, especially among young, sexually-active women. Around 4% of women aged 15 to 24 tested positive for the disease, compared to 1% of men in the same age group and under 1% for both men and women in other age groups. Chlamydia is generally asymptomatic in women, the report notes, meaning that many then act as unwitting carriers of the disease to male partners.

Syphilis and gonorrhea are less common, the report notes. However, both have seen recent rises in prevalence, after falling to historic lows in the early 2000s. Gonorrhea infections in particular increased by 82.6% since reaching a historic low in 2009. The CDC suggested that “multiple factors” are at play, including “drug use, poverty, stigma, and unstable housing, which can reduce access to STD prevention and care,” “decreased condom use among vulnerable groups,” and “cuts to STD programs at the state and local level.”

Both increases seem to be primarily driven by “men who have sex with men” (MSM, a stated-sexual-preference-neutral term used by the CDC and other public health organizations). MSM accounted for the majority of primary and secondary syphilis diagnoses since at least 2014, the report adds. By 2015, MSMs were 24 more likely to have gonorrhea than women, and 31 times more likely than “men who have sex with women.” In a companion release, the CDC suggested that “multiple factors, including individual behaviors and sexual network characteristics,” may determine the high prevalence of STDs among MSM. Those network characteristics included “high prevalence of STDs, interconnectedness and concurrency of sex partners, and possibly limited access to healthcare,” as well as socioeconomic disadvantage among certain MSM subpopulations.

One of the most heartbreaking findings from the study is a dramatic increase in syphilis cases among newborns (congenital syphilis); the reported number of such cases nearly tripled since 2014 to 1,306 cases in 2018.

Antibiotic-resistant gonorrhea is also featured in the report. The CDC explains that over half of such infections reported in 2018 were resistant to at least one antibiotic. However, the centers also explain that ceftriaxone, the ‘first line of defense against gonorrhea’, remains effective at its intended role.

The full report “Sexually transmitted diseases Surveillance 2018” is available here.

Gonorrhea and syphilis continue to surge amid government cuts

A report published by Public Health England (PHE) found that there was a 20% increase in syphilis in the UK. It’s the largest number of reported cases since 1949. Gonorrhea is also on the rise.

These babies are still the best way to prevent STIs.

The good news is that overall, the rates of sexually transmitted infections (STIs) remained stable in 2017 compared to 2016 — but there’s also a lot of bad news. Following the 10-year trend, syphilis rates continue to grow, with the vast majority of cases (78%) being reported in gay, bisexual and other men who have sex with men. Black and minority ethnic populations are also disproportionately affected.

Across all STIs, the highest rates of diagnoses are reported among individuals aged 16 to 24, which again, is both good and bad news. The good news is that these cases can likely be prevented by simply using a condom, and awareness campaigns (especially in schools and universities) can have a big impact. The bad news is that the health impact of these infections can be devastating.

Dr. Gwenda Hughes, Consultant Scientist and Head of Sexually Transmitted Infection (STI) Section at PHE, said:

“Sexually transmitted infections pose serious consequences to health – both your own and that of your current and future sexual partners. The impact of STIs can be considerable, with some causing infertility, pelvic inflammatory disease and harm to unborn babies. Consistent and correct condom use with new and casual partners is the best defence against STIs, and if you are at risk, regular check-ups are essential to enable early diagnosis and treatment.”

Doctors and researchers have expressed great concern at the rise of gonorrhea, which is threatening to become completely drug-resistant. In March, the first case of super-gonorrhea was detected in the UK, and drug resistance is one of the main reasons of health concerns worldwide. Meanwhile, the government continues to make significant cuts to the management of these diseases.

Overall, there were 422,000 diagnoses of sexually transmitted infections (STIs) made in England, including 7,137 diagnoses of syphilis and 44,676 diagnoses of gonorrhea.

However, the report ends on a very positive note. Genital warts have decreased by a whopping 90% since 2009, reflecting the widespread administration of the Human Papilloma Virus vaccine in girls aged 12-13. It’s another case of vaccines pushing back a very dangerous disease

Read the full report and breakdown of data here.

Neisseria gonorrhoeae

World-first case of antibiotic-resistant gonorrhea, identified in the UK

Public Health England released the first global report of antibiotic-resistant gonorrhea.

Neisseria gonorrhoeae

Colourised scanning electron micrograph of Neisseria gonorrhoeae bacteria.
image via National Institute of Allergy and Infectious Diseases / Flickr

A UK man is the first on record to contract a strand of gonorrhea that can shrug off our main antibiotic treatment against the disease. The report, issued by Public Health England (PHE), notes that while he had a regular partner in the UK, the man contracted the infection following a sexual encounter with a woman in south-east Asia.

He first visited a health clinic for treatment in early 2018. However, although doctors placed him on the recommended treatment for the disease — a cocktail of antibiotics azithromycin and ceftriaxone — the infection persists, according to The Guardian.

“We are investigating a case who has gonorrhoea which was acquired abroad and is very resistant to the recommended first line treatment,” said Dr Gwenda Hughes, the head of PHE’s STI section.

“This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.”

The man is currently receiving an intravenous treatment course of ertapenem, an antibiotic used as a last line of defense against multidrug-resistant bacteria. So far, it seems to be effective — lab tests scheduled for April will tell whether or not this is the case. The man’s partner tested negative for infection. However, authorities have traced the man’s sexual partners to ensure that the strain didn’t spread.

“We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” Hughes adds.

Symptoms of gonorrhea include inflammation, a burning sensation when urinating, and unusual discharge from the sexual organ. Left untreated, the infection can cause other serious health problems, including long-term abdominal pain and pelvic inflammatory disease. But what makes the prospect of antibiotic-resistant strains really menacing is that these complications often lead to infertility.

The WHO estimates that some 78 million people worldwide contract gonorrhea each year. In the US, CDC estimates place the number of new infections at around 820,000 countrywide per year. Worse still, gonorrhea has shown a worrying trend of successive adaptation to our antibiotic treatments over the last few years. That’s why Hughes stressed the importance of practicing safe sex:

“It is better to avoid getting or passing on gonorrhoea in the first place and everyone can significantly reduce their risk by using condoms consistently and correctly with all new and casual partners,” she said in a statement.

Still, the report is a confirmation of healthcare authorities’ greatest fear: drug-resistant gonorrhea is spreading around the globe. Massive research efforts have led to an effective vaccine against the disease — but at the time of writing this, we’re still very far away from a fail-proof vaccine; currently, it only reduces the disease’s incidence by 31%, one in every three cases.

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For the first time, a vaccine for gonorrhea proves effective

As we reported earlier today, the world is slowly losing the battle with gonorrhea. Some bacterial strains that cause gonorrhea seem to have garnered immunity to virtually all the antibiotics we can throw at them, and infection rates aren’t slowing down. Now, there are quite a few patients that are stuck with this STD which everyone considers rather benign — because it used to be. But not anymore, that’s for sure. The good news is that a mass vaccination campaign in New Zealand seems to significantly reduce the likelihood of contracting gonorrhea compared to a control group that didn’t receive the vaccine. It’s the first time that a vaccine is shown to provide protection against the disease.

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Credit: Pixabay.

More than a century of research has been dedicated to a vaccine for gonorrhea with little success reported. When there was some promising progress, once it reached the clinical trial stage the treatment proved ineffective. It happened on at least four separate occasions. But not this time.

The team led by Dr Helen Petousis-Harris, University of Auckland, New Zealand, administered the meningococcal group B vaccine for a clinical trial that involved 14,000 people. Approximately one million individuals, including 81% of the population under 20 years, received the MeNZB vaccine which targets the Neisseria meningitidis bacteria but works against the Neisseria gonorrhoeae bacteria too, with which it has an 80-90% genetic match. Individuals from Cuba and Norway also received the vaccine.

Researchers reported that vaccinated individuals were far less likely to have gonorrhea than the controls (41% vs 51%). After factoring for such things as ethnicity, gender or geographical area, the team concluded that the MeNZB vaccine reduced the incidence of gonorrhea by 31%.

That might not seem like the best protection but we should all bear in mind these are the first results that show at least some degree of significant protection against the disease. We don’t know yet why the vaccine seems to protect some people but not others.

“Our findings provide experimental evidence and a proof of principle that an OMV meningococcal group B vaccine could offer moderate cross-protection against gonorrhoea. This is the first time a vaccine has shown any protection against gonorrhoea. At the moment, the mechanism behind this immune response is unknown, but our findings could inform future vaccine development for both the meningococcal and gonorrhoea vaccines,” Peteousis-Harris said in a statement.

The designers of the vaccine initially hand in mind to control meningitis epidemics but once OMV antigens known to prove an immune response to gonorrhea were added, the vaccine proved useful against the STD as well.

Even at a 30% efficacy rate, if immunity is maintained, the vaccine could reduce the prevalence of gonorrhea by more than 30% in the next 15 years. Great protection over a shorter period of time can be achieved by raising the efficacy.

“The potential ability of an OMV group B meningococcal vaccine to provide even moderate protection against gonorrhoea would have substantial public health benefits in view of the prevalence of gonorrhoea, and the increase in antibiotic resistance. If the 4CMenB vaccine, which is currently available in many countries, is shown to have a similar effect to the MeNZB vaccine, then administering it in adolescent immunisation programmes could result in declines in gonorrhoea,” said co-author Professor Steven Black, Cincinnati Children’s Hospital, USA.

Because so many mutated strains existed around the world — including some that are totally immune to known antibiotics — the researchers caution that the vaccine might not work everywhere and thus warrant more research.

Findings appeared in the journal The Lancet.

Oral sex might be helping the spread of unstoppable bacteria

Who thought oral sex might be bad for the planet? According to the World Health Organization (WHO), drug-resistant gonorrhea is spreading at an alarming pace, and oral sex is helping fuel it.

Gonorrhea affects about 0.8% of women and 0.6% of men, with an estimated 33 to 106 million new cases each year (out of the almost 500 million cases of sexually transmitted infections). In recent years, some instances of the bacteria have become drug-resistant and almost impossible to treat, prompting the WHO to list it as one of the world’s biggest health threats. There are reasonable concerns that it might simply become incurable.

Speaking to the BBC, Prof Richard Stabler, from the London School of Hygiene & Tropical Medicine, expressed the gravity of the situation:

“Ever since the introduction of penicillin, hailed as a reliable and quick cure, gonorrhoea has developed resistance to all therapeutic antibiotics. In the past 15 years therapy has had to change three times following increasing rates of resistance worldwide. We are now at a point where we are using the drugs of last resort, but there are worrying signs as treatment failure due to resistant strains has been documented.”

There are three main ways to tackle this issue: developing new antibiotics, preventing its spread, and vaccines. The first one is not looking so good. Dr. Manica Balasegaram, from the Global Antibiotic Research and Development Partnership, said:

“The situation is fairly grim. There are only three drug candidates in the entire drug [development] pipeline and no guarantee any will make it out.”

The second part is all about limiting its spread. There’s no realistic way we can stop all infected people from having unsafe sex, especially since gonorrhea is often without any visible symptoms. This is where oral sex is stepping into the scene.

It’s hard to say if people are doing more of it nowadays because data on it is so scarce. In fact, oral sex fits an interesting position in our society: most people do it, but we never talk about it. A 2001 survey in the UK found that 77.9% of men and 76.8% of women have given and/or received oral sex in the past year. Rates are similar in Europe and the US. It’s important to realize that oral sex also passes on a lot of infections — just like regular sex does. Gonorrhea, genital herpes, and syphilis are easily passed this way, whereas, chlamydia, HIV,  hepatitis A, hepatitis B, and hepatitis C, genital warts, and pubic lice are passed less frequently. So if you’re having safe sex but unprotected oral sex, you’re still at some risk.

Of course, doctors acknowledge that this will change few people’s minds, but at least it’s important to acknowledge it.

The last, and probably decisive, course of action will be vaccines. Current control measures are inadequate and seriously threatened by the rapid emergence of antibiotic resistance, a 2014 study reports, highlighting the need for a gonorrhea vaccine. Such a vaccine has been demonstrated on mice populations, but human trials have yet to be carried out.

Gonorrhea might soon become untreatable, World Health Organization warns

U.N. health officials have issued a grim warning: we’re running out of ways to treat gonorrhea.

Not anymore it doesn’t. Image from 1944.

Gonorrhea is a relatively common disease, infecting 78 million people each year. Anyone who is sexually active can get gonorrhea, and the disease can spread like wildfire through unprotected sex. Some infected people have no symptoms at all, while others may experience burning with urination, and a swarm of other genital affections. If untreated gonorrhea can occasionally spread to affect joints or heart valves.

Traditionally, treating gonorrhea has been easy with antibiotics. But resistance to antibiotics has grown dramatically in recent years. Strains of multidrug-resistant gonorrhea that do not respond to any available antibiotics have already been detected, the main cause for this being antibiotics overuse in trivial cases.

“‘Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline and doxycycline — very commonly used drugs,’ said Jonathan Zenilman, who studies infectious diseases at Johns Hopkins. “But one by one, each of those antibiotics — and almost every new one that has come along since — eventually stopped working. One reason is that the bacterium that causes gonorrhea can mutate quickly to defend itself, Zenilman said.

If we were to study this adaptation from an external perspective, it’s truly admirable. The bacteria has shown a remarkable resilience and capacity to evolve.

“‘If this was a person, this person would be incredibly creative,’ he said. ‘The bug has an incredible ability to adapt and just develop new mechanisms of resisting the impact of these drugs.'”

However, we don’t study it from an external perspective. This bacteria affects us, and has the potential to become very dangerous. In light of this adaptation, the World Health Organization released new guidelines warning doctors that it no longer recommends an entire class of antibiotics for treating gonorrhea. Namely, they recommened stopping using quinolones, because quinolone-resistant strains of the disease have been reported in many parts of the world. Quinolones antibiotic medications include: Ciprofloxacin (Ciloxan Ophthalmic and Cipro) Levofloxacin (Levaquin and QUIXIN Ophthalmic) Lomefloxacin (Maxaquin) Moxifloxacin (Avelox).

Instead, it recommends using cephalosporins, another class of antibiotic, but there are worries that it’s only a matter of time before the disease will develop resistance to these too. In the meantime, scientists are working on solutions that either do the job without antibiotics or enhance them, such as the gonorrhea vaccine developed at S.U.N.Y. Buffalo.

New Treatment for Gonorrhea Acts like a Vaccine, Preventing Reinfection

A first step has been taken towards an effective treatment for Gonorrhea – with drug resistant strains on the rise, this moment comes just at the right time, merely days after the U.S. Centers for Disease Control (CDC) placed the STD on a list of “urgent threats” in the fight against drug-resistant bacteria.

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Gonorrhea (colloquially known as the clap) is a common sexually transmitted infection which affects more than 700,000 people in the United States each year. It’s a serious disease, but nothing really dramatic – or at least that’s how the situation was up until a few years; in the past decade,has progressively developed resistance to the antibiotic drugs prescribed to treat it. According to the CDC the bacteria which causes the disease in humans initially leads to painful inflammation and discharge, but if not treated properly, can cause infertility and can even be fatal. Researchers from the University at Buffalo, think that the answer doesn’t lie in more powerful drugs, but in making the body react better to the threat.

They showed that the disease could be cured by introducing into the genital tract a cytokine, or immunoregulatory protein, known as interleukin-12 (IL-12), which is also currently investigated as an anti-cancer agent. Michael Russell, a microbiologist and immunologist at S.U.N.Y. Buffalo has been working on the STD for some 20 years, and he his studies seem to indicate that it directly affects immune systems.

He tested his method on mice and…

“And it worked,” he says, “very nicely.”

Not only did mice treated with IL-12 respond more quickly to antibiotics, they were also significantly less likely to contact the same strain a month later – which is a constant problem with gonorrhea. Of course, the drug has the potential to do wonders against the disease, but Russell wants to push things even further – transform the infection into a “living vaccine”:

“Since the second world war,” Russell says, “we’ve been treating infections by throwing antibiotics at them. Now that bacteria are emerging with antibiotic resistance, we have nothing else in the pipeline to deal with gonorrhea.” But the IL-12 treatment, he says, can turn the infection into a “live vaccine,” allowing the body to develop immunity.

However, even with the massive amount of pressure caused by the imminent antibiotic-resistant germ crisis, the method is miles away for being suitable for humans. But eventually he hopes to see this novel approach to the treatment of gonorrhea and other infectious diseases.

Source

Gonorrhea under a microscope. Image: courtesy of CDC/Susan Lindsley

Antibiotic resistant gonorrhea arrives in North America too. STD might become “incurable”

Gonorrhea under a microscope. Image: courtesy of CDC/Susan Lindsley

Gonorrhea is one of the most common sexually transmitted disease in the world. It’s been a real pest for centuries, however for decades now effective and simple orally administrated antibiotics have quickly turned this dreaded social stigma and healthcare hazard into nothing more than a common trifle, easily dealt with. The bacterium doesn’t give up that easily though, and along countless generations it has developed immunity to the various antibiotics physicians have thrown at it.

In the past few years, cases of gonorrhea that didn’t respond to treatment were reported through the world. A recent survey found that “incurable” gonorrhea has also reach North America, after researchers at a Toronto clinic found that 6.7 percent of 133 patients that came for treatment still remained gonorrhea-positive after re-testing.

The current antibiotic of choice for treating gonorrhea is a class called cephalosporins. Previously other classes were used, but they steadily lost the battle as the bacterium developed immunity. Thus, sulfonamides lost potency in the 1940s, penicillins and tetracyclines lost effectiveness in the 1970s and ’80s, while fluoroquinolones were permanently retired in 2007.

Previously, individual cases of untreatable gonorrhea were reported in the United Kingdom, Austria, France, Norway, and Japan. This latest survey, led by Vanessa Allen of Public Health Ontario, proves for the first time cephalosporin-resistant gonorrhea has been found in humans in North America.

“These are the clinical cases we’ve been waiting for,” Allen says. “This is the translation of the lab information into what the clinical consequence is.”

Gonorrhea is winning

Gonorrhea is estimated to infect close to 700,000 Americans each year. Left untreated, it can cause very unpleasant complications like painful urination, abdominal pain, genital discharge, itching and more severely severe pregnancy complications and female infertility. The STD also heightens the risk of acquiring HIV, and babies born to women with untreated gonorrhea are at risk of blindness.

“Our results aren’t generalizable to the overall concentration because they all came from one clinic,” Allen says. “But basically, the problem appears worse than we originally thought.”

Does this mean that gonorrhea will become incurable in the future? Not necessarily. All the nine patients that didn’t respond to the typical oral antibiotics were eventually cured with the injectable antibiotic known as ceftriaxone, which unfortunately has also seen a parallel development of resistance according to Allen. While the antibiotic pipeline is obviously running dry, hopefully alternative forms of treatment may be developed, however it’s unlikely they are as “comfortable” and non-intrusive than cephalosporins.

Considering these recent worldwide cases of drug resistance, the U.S. Centers for Disease Control and Prevention (CDC) recently recommended clinicians no longer prescribe a single antibiotic treatment. Robert Kirkcaldy, of the Division of STD Prevention at the CDC, stated:

“[…] all patients treated for gonorrhea should be given risk reduction counseling, offered condoms and retested for gonorrhea three months after treatment,” they noted in their essay.

“Clinicians must remain vigilant for cephalosporin treatment failures and report suspected cases to the local or state health department,” Kirkcaldy and his colleagues wrote. “Patients with persistent or recurrent symptoms shortly after treatment should be retested for gonorrhea by culture.”

The findings were reported in theJournal of the American Medical Association