United States investigates first cases of

Massachusetts health authorities announced Thursday that they have identified two cases of a new strain of gonorrhea that appears to have developed resistance to a wide range of antibiotic treatments.

Both patients improved after receiving injections of ceftriaxone, the main drug currently recommended to treat cases of sexually transmitted infection. But state health officials warn that the strain that infected them shows signs of at least some resistance to nearly all drugs used to treat the bacteria, the first of its kind confirmed in the US to date.

The researchers are now working with the Centers for Disease Control and Prevention to test other samples collected from gonorrhea cases in the state. Massachusetts is also conducting contact tracing to find out if the drug-resistant strain has spread to others.

“The discovery of this strain of gonorrhea is a serious public health concern that the DPH, CDC and other health departments have been vigilant about,” Margret Cooke, chief of the Massachusetts Department of Public Health, said Thursday in a release.

Gonorrhea is the second most common sexually transmitted infection reported to health authorities in the US, behind chlamydia, according to the CDC.

Many of those who are infected by the bacteria often have few or no symptoms. However, some may develop bleeding, discharge, and more serious complications that can lead to infertility and pain.

The initial case was identified in a patient who attended a primary care clinic with symptoms of urethritis, a type of irritation that can make urination difficult. Samples examined by the state health laboratory revealed a “worrying” pattern later verified by follow-up testing by the CDC.

A state spokesman declined to provide additional details about the two cases beyond those identified in the department’s announcement and provider alert.

No direct connection between the two cases has been identified. One had no recent travel history, suggesting the strain may be spreading within the state.

“We urge all sexually active people to be regularly tested for sexually transmitted infections and to consider reducing the number of their sexual partners and increasing the use of condoms when having sex,” Cooke said.

Gonorrhea’s “alarming” drug resistance

For years, health authorities have been working to respond to the “alarming” ability of gonorrhea to develop resistance to antibiotics that have been deployed to fight it.

In 2013, the CDC named gonorrhea one of the three most pressing threats posed by antibiotic-resistant bacteria. Both US and global health authorities have launched campaigns to curb new cases of gonorrhea in the hope of controlling the bacteria until vaccines and new treatments are developed.

The Massachusetts cases are the first laboratory-confirmed cases that have developed the ability to circumvent six of the seven drugs that health authorities track for potential resistance. It carries a change in the “penA60 allele”, a genetic mutation, which has been linked to previous cases of resistance to ceftriaxone in Nevada, the UK and Asia.

“This case is a reminder that antimicrobial-resistant gonorrhea remains an urgent national and international public health threat; all providers in all clinical settings must remain vigilant,” said Dr. Laura Hinkle Bachmann, medical director of the CDC’s Division of STD Prevention, she said Thursday in a letter to providers.

Ceftriaxone injections, boosted with other oral antibiotics such as azithromycin and doxycycline, have been the last recommended treatment for gonorrhea since 2012. At that time, laboratory data showed that a related drug known as cefixime had been losing efficacy and ran the risk of creating resistance to ceftriaxone as well.

Only one drug tested against the Massachusetts strain by the CDC panel, gentamicin, showed no sign of reduced susceptibility. However, that drug is already generally considered a less effective treatment. for gonorrhea

Scientists have searched for new gonorrhea drugs such as zoliflodacin, which showed promising initial results in a 2018 study supported by the National Institutes of Health. That drug is currently being studied in clinical trials and has not been approved by the Food and Drug Administration for gonorrhea.

“Timely identification and treatment, as well as a rapid public health response, are essential to keep patients safe and reduce the risk of community transmission. We must all remain alert to possible gonococcal treatment failure as we combat the growing threat of antimicrobial resistance,” Bachmann said. saying.

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