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Massachusetts detects troubling new strain of gonorrhea

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“The time is approaching. [patients] Dr. Catherine Su, medical director of the Massachusetts Department of Public Health’s STD Prevention and HIV/AIDS Division, says she may no longer respond to the drug.

The discovery comes at a time when sexually transmitted diseases, especially gonorrhea, are surging nationwide, raising concerns that many microbes are capable of outwitting the drugs used to kill them. I got

“We have very few, very few options,” said Helen Boucher, Ph. He said: “This is a common infection in young, healthy people. … There is only one thing, and that one thing can stop working.”

Dr. Luann Barnabas, director of the Division of Infectious Diseases at Massachusetts General Hospital, called the strain’s discovery “significant.”

“But given how fluid we are as a global community, it’s not surprising,” she said.

The Massachusetts news is a reminder to doctors and patients to take gonorrhea seriously and monitor for signs of resistance, said Laura Backman, M.D., chief medical officer for the CDC’s STD Prevention Division. I’m here.

The Centers for Disease Control and Prevention and state health officials sent an alert to providers Thursday afternoon. The Massachusetts state alert said the finding was a warning that gonorrhea “has become less responsive to its limited arsenal of antibiotics.”

“The message to providers is, ‘We have to pay attention to this,'” Bachmann said. “Antimicrobial resistance is an important and urgent public health threat.”

Still, the CDC hasn’t changed its recommendations for testing and treating gonorrhea. Bachmann said it was “encouraging” that both Massachusetts patients were cured with her single injection of ceftriaxone, the standard of care.

The strain is endemic in the Asia-Pacific region, with 10 recent cases confirmed in the United Kingdom. A British patient was also cured with ceftriaxone.

If ceftriaxone stops working, doctors say there are alternatives, but they are riskier or less effective.

“We want to keep the options that we have,” said Varnavas.

She added that a potential vaccine is in development.

Several new antibiotics that may work are also in the pipeline, but “economic realities” are slowing progress and companies working on them are bankrupt, Boucher said. .

Gonorrhea is a common and rapidly spreading sexually transmitted disease. Its incidence increased by 45% from 2016 to 2020, and more than half of those infected were between the ages of 15 and 24. In Massachusetts, laboratory-confirmed gonorrhea cases have quadrupled from a low of 1,976 cases in 2009 to 8,133 in 2021, he said. The bacteria that cause it not only infect the mucous membranes of the reproductive tract and urethra in women and men, but also the mouth, throat, eyes, and rectum.

In many cases, infected people have no symptoms. That’s why the CDC recommends screening tests for sexually active people. If symptoms do occur, they may include pain when urinating and discharge from the urethra or vagina.

If untreated, gonorrhea can lead to pelvic inflammatory disease and infertility in women, and inflammation of the scrotum in men. there is.

The Massachusetts case was discovered as part of a routine testing process. The family doctor performed standard tests to identify gonorrhea and also cultured samples. After culture confirmed that the infection was gonorrhea, an isolate of the organism was sent to a state laboratory for further testing for drug resistance.

The sample showed signs of resistance, so the state sent it to the CDC for more advanced testing to identify worrisome genetic patterns. , ceftriaxone, cefixime, and azithromycin.

This prompted the Department of Health to ask clinical laboratories in the same area to send additional samples around the same time. Further testing at the CDC revealed a second case.

Health officials determined the two cases were not related, and Barnabas said he was certain there were more than one person infected with the new strain. However, there is no information indicating how widespread the new bug is. A similar, less resistant strain was identified in Nevada in 2019 and has not been seen since.

“Unless we scale up our surveillance, we can’t be sure,” Su said, adding that now is “a pivotal positive moment for public health.”

Bachmann said it’s possible that the strain is circulating elsewhere. “This is why it’s so important for providers to keep an eye on the radar and public health departments and pay attention to treatment failures.”

“To prevent resistance, it is very important to identify gonorrhea quickly and treat it appropriately with the right drugs in the right dose at the right time. We need to tune in to better treatment.”

The Massachusetts Department of Health followed protocols for treating gonorrhea with high-dose ceftriaxone, taking cultures from symptomatic cases of gonorrhea, and submitting samples to state laboratories, according to which the patient was cured after treatment. In addition, sexually active women under the age of 24, at-risk women, and sexually active men who have sex with men should be tested regularly. screening is recommended.

On what individuals can do, Surgeon General Margret Cook advised in a statement: when you have sex. “

Felice J. Freyer can be reached at felice.freyer@globe.com. follow her on her twitter @felicejfreyer.

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