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Antibiotic-Resistant Gonorrhea Spreading: WHO

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, June 6 (HealthDay News) -- Gonorrhea, the second most common sexually transmitted disease, is rapidly growing resistant to the last class of antibiotics that can effectively treat the infection, the World Health Organization warned Wednesday.

A number of countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom, are reporting cases of antibiotic-resistant gonorrhea. The infection can lead to a series of serious health problems for both men and women, including infertility, increased risk of HIV infection, and potentially blinding eye infections in newborns, the WHO said.

Every year some 106 million people around the world are infected with gonorrhea, the U.N. health agency said.

According to the U.S. Centers for Disease Control and Prevention, more than 700,000 people in the United States get new gonorrhea infections each year and less than half of these infections are reported to the CDC.

In recommendations released Wednesday, the WHO called for greater oversight on the correct use of antibiotics and more research into alternative treatments for infections. The agency's Global Action Plan also urges increased monitoring and reporting of resistant strains of the disease, as well as better prevention, diagnosis and control of infections.

"Gonorrhea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options," Dr. Manjula Lusti-Narasimhan, of WHO's Department of Reproductive Health and Research, said in a news release.

"The available data only shows the tip of the iceberg. Without adequate surveillance we won't know the extent of resistance to gonorrhea and without research into new antimicrobial agents, there could soon be no effective treatment for patients," she added.

Gonorrhea accounts for one quarter of the four major, curable sexually transmitted diseases, WHO noted, and it's the second most common sexually transmitted infection after chlamydia.

Since the development of antibiotics, gonorrhea has developed resistance to a variety of antibiotics, including penicillin and tetracyclines, and appears to be developing resistance to cephalosporins, the last line of drug defense, the agency said.

"We are very concerned about recent reports of treatment failure from the last effective treatment option -- the class of cephalosporin antibiotics --as there are no new therapeutic drugs in development," Lusti-Narasimhan said. "If gonococcal infections become untreatable, the health implications are significant."

Untreated gonorrhea can lead to health problems for men, women and newborns, the WHO said, including: infection of the urethra, cervix and rectum; infertility in both men and women; increased risk of HIV infection and transmission; ectopic pregnancies; miscarriage, stillbirths and premature deliveries; and severe eye infections in up to 50 percent of babies born to women with untreated gonorrhea that can lead to blindness.

Gonorrhea can be prevented through safe sex practices. Early detection and treatment, including of sex partners, is essential to control sexually transmitted diseases, WHO said.

Dr. Marc Siegel, an associate professor of medicine at the NYU Langone Medical Center in New York City, said, "WHO is right, gonorrhea is a rampant worldwide problem."

"It's also true that there are more resistant strains coming out," he said. But, in underdeveloped areas these strains are mostly sensitive to antibiotics, because in these areas there isn't a lot of antibiotic use, he added.

"We do need more public health measures, we need more education, and we need a heck of a lot more condom use," Siegel said.

Another leading U.S. infectious disease expert said the situation may not be as dire in America.

"The number of cases of gonorrhea in the U.S. has been significantly falling for a number of years. In 2009 there were 301,000 cases, representing a 10 percent decline from 2008. That trend has continued," said Dr. Pascal James Imperato, dean of the School of Public Health at State University of New York Downstate Medical Center. "I present this by way of background since gonorrhea, as a sexually transmitted disease, has been and continues to be on a downward decline in the U.S.

"Here in the U.S., a double antibiotic regimen has been in place over the past few years consisting of a cephalosporin and azithromycin or azithromycin and doxycycline," he explained.

"Thus far, organisms in the U.S. are still susceptible to some of the cephalosporins and remain susceptible to other antibiotics as well," Imperato said.

More information

For more on gonorrhea, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Marc Siegel, M.D., associate professor, medicine, NYU Langone Medical Center, New York City; Pascal James Imperato, M.D., dean, School of Public Health, State University of New York Downstate Medical Center, New York City; World Health Organization, news release, June 6, 2012

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