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One treatment left standing for gonorrhea

Bacteria’s ability to mutate fast helps it resist most antibiotics

As health advocates have warned for years: This is not your father’s gonorrhea.

In the old days, all it took to wipe out most cases of “the clap,” a sexually transmitted bacterial infection, was a course of penicillin.

No more. The bacteria’s ability to mutate fast, coupled with the misuse of antibiotics, has allowed the bacteria to grow resistant to penicillin and most other antibiotics used to treat it.

Now, as reflected in a federal agency’s new treatment guidelines, there’s one class of antibiotics left to wipe out a case of gonorrhea. If the bacteria become resistant to those drugs, gonorrhea may become untreatable.

While he’s hopeful new drugs will be developed to replace it, no one really knows how long the recommended antibiotic will work against gonorrhea, said Dr. Joel McCullough, health officer for the Spokane Regional Health District.

“We’re dealing with a bacteria that’s at the head of the class,” he said.

In the meantime, the recommended drug – delivered via injection rather than pill form – poses some challenges for patients and health care providers.

The Centers for Disease Control and Prevention last month recommended that gonorrhea be treated with just one drug from a class of antibiotics called cephalosporins, instead of giving doctors a choice between two drugs in that class. It’s an effort to preserve that one drug as an effective treatment for as long as possible.

Gonorrhea has shown resistance to the drug cefixime, taken in pill form. Researchers fear continued use of that drug may help gonorrhea develop resistance to all cephalosporins.

The recommended drug, ceftriaxone, is delivered via injection. Treatment is harder logistically – patients have to go to a doctor’s office to get a shot rather than picking up a prescription. (To help ward off resistance, ceftriaxone should be given in combination with one of two other oral antibiotics, the CDC says.)

Whether health care providers can get the antibiotic to patients’ possibly infected partners may be a bigger problem, said Karl Eastlund, president of Planned Parenthood of Greater Washington and North Idaho. Planned Parenthood is the largest reporter of sexually transmitted infections to the Spokane health district.

In the past, infected patients could deliver packets of medication to their partners. Planned Parenthood will still provide those packets in some cases, but now it’s generally up to the partners to go to the medical office to get a shot, which some are reluctant to do. That reluctance may be based partly in a sense of denial that they may be infected, Eastlund said, made easier to sustain because gonorrhea’s “No. 1 symptom is no symptom.”

In Spokane County, as well as nationwide, gonorrhea affects young people the most.

In Spokane County, people ages 15 to 24 suffered more than half the new gonorrhea infections reported in 2010, according to statistics from the state Department of Health. Of 137 cases reported, those young people represented 73 cases.

Two more were in children ages 10 to 14. And 26 cases were adults ages 25 to 29.

Nearly twice as many girls and young women were diagnosed as boys and young men – 46 females ages 15 to 24 in 2010, compared with 27 males, according to the state statistics.

Overall, Spokane County ranks eighth among the state’s 39 counties for gonorrhea infection rates. It’s the county’s second-most commonly reported sexually transmitted infection, after chlamydia.

Despite the new treatment guidelines, gonorrhea remains curable in most cases. After the antibiotic wipes out the infection, the patient can no longer pass it on.

But left untreated, it can move to a woman’s uterus or fallopian tubes, causing pelvic inflammatory disease, which can leave her unable to have children or at higher risk of life-threatening ectopic pregnancy. In men, gonorrhea can cause painful swelling in the tubes attached to the testicles, which also can cause infertility.

No antibiotic-resistant strains have been identified in Spokane or the state, said Lisa St. John, who manages the health district’s STD program.

Elsewhere in the U.S., they’ve been identified only in labs. But untreatable gonorrhea has popped up in people in Asia, Australia and Europe.

It’s up to health care providers to watch carefully for resistant strains in the area, testing patients who don’t seem to be responding to treatment, said Dr. Denise Bayuszik, medical director for the region’s Planned Parenthood chapter.

The CDC’s new recommendation comes as no surprise to the Spokane health district, which changed its guidelines for local health providers in 2010, based on guidelines from the state Department of Health. Planned Parenthood also previously changed its treatment protocol.

But it does underscore the need to use protection to stop the spread of STDs and get tested regularly, health advocates say.

“It’s more important now than ever to be safe to protect yourself,” said Eastlund, of Planned Parenthood. “With drug-resistant bacteria, it’s not going to get easier, it’s going to get harder to treat gonorrhea.”