The last drug that can fight gonorrhea is starting to falter

To the unfamiliar eye, the press release from the Massachusetts Department of Health two weeks ago looked pretty mundane. Perhaps his language was a little unnerving, but carefully worded: Analysts found a resident with a strain of gonorrhea that showed a “reduced response to several antibiotics,” but that person – and a second with a similar infection – were cured.

To a civilian, this announcement might have seemed like a boat hitting a small wave: a moment of loss of balance, and then returning to normal. To people in public health and medicine, it was more like Titanic and iceberg detection.

Here’s what was actually on the news: a disease so old and basic that we hardly think about it, even though it strikes nearly 700,000 Americans per year, overcomes the latest antibiotics now available for its treatment. If he gets a chance to evade these drugs, our only recourse will be to search desperately for others not yet approved, or to go back to a time when untreated gonorrhea caused disabling arthritis, blinded babies at birth, and made men sterile. through testicle damage and women through pelvic inflammatory disease.

Professionals get tired of seeing an iceberg approaching. Gonorrhea is not like Covid, a new pathogen that has taken us by surprise and required heroic efforts in research and medical care. It’s a known enemy as old as recorded historywith a predictable response to treatment and an equally predictable history of antibiotic resistance.

However, he is ahead of us. The discovery in Massachusetts is “alarming,” says Jonathan Grad, an infectious disease physician, researcher and assistant professor at the Harvard T. H. Chan School of Public Health. “This is a confirmation of a trend that we knew about. It’s expected to get worse.”

A little more about the announcement: The Massachusetts Department of State has announced that a person has been diagnosed with a new strain of gonorrhea that carries a constellation of features never before seen in any bacterial sample in the US. These traits included the genomic signature previously seen in patients. In Great BritainAsia and one man in Nevada-called handleA60 allele. But genomic analysis showed that it also showed complete resistance to three antibiotics and some resistance to three more for the first time. One is the drug of last resort in the US: an injectable cephalosporin antibiotic called ceftriaxone.

In 2020 CDC stated that physicians should only prescribe ceftriaxone for gonorrhea because all other antibiotics historically used against the infection have lost their effectiveness. Fortunately, the substantial dose recommended by the Centers for Disease Control and Prevention (CDC) still worked for this patient. He also cured a second person who, according to the health department, had nothing to do with the first and was a carrier of the same strain with the same type of resistance. But experts believe the reduced susceptibility indicates that ceftriaxone may also disappear.

“This situation is both a warning and an opportunity,” says Kathleen Roosevelt, director of the Massachusetts Division of STD Prevention and HIV Surveillance, stressing that rates of gonorrhea are declining. at all-time highs in the US. To try to curb this trend, her agency has sent out instructions to every frontline health worker in the state, asking them to interview patients who test positive in detail, urge those who have been treated to come back to make sure they are cured… and most importantly, change the way clinics screen patients for infection.