To someone you don’t know eye, the press release from the Massachusetts Department of Public Health two weeks ago looked rather routine. Its language is a bit intimidating, maybe, but carefully expressed: Analysts found one resident with a strain of gonorrhea showed “reduced responses to many antibiotics,” but that person — and a second person with a similar infection — was cured.
To a civilian, the announcement can be like a small wave hitting a boat: losing balance for a moment, then returning to normal. For those in the medical and public health fields, it feels like being on top Titanic and discovered the iceberg.
Here’s what the newsletter really said: A disease so old and so fundamental that we hardly think about it, even though it affects nearly 700,000 Americans a year, is surpassing the last available antibiotics to treat it. If it’s possible to evade those drugs, our only options will be to desperately seek other unapproved drugs — or go back to the days when untreated gonorrhea caused it. crippling arthritis, newborns go blind when they are born, and infertile men through damage to the testicles and women through pelvic inflammatory disease.
What was exhausting, for the experts, was that they saw the iceberg coming. Gonorrhea is not like Covid, a new pathogen that surprises us and requires heroic medical care and research efforts. It’s a well-known enemy, like as old as history recordedwith a predictable response to treatment and a similarly predictable profile of antibiotic resistance.
However, it is ahead of us. Yonatan Grad, a physician and infectious disease researcher and associate professor at the Harvard TH Chan School of Public Health, said the discovery in Massachusetts was “very alarming”. “It is confirmation of a trend that we know is happening. And the expectation is, it will get worse.”
A little more detail on the announcement: The Massachusetts Department said this person has been diagnosed with a new strain of gonorrhea carrying a constellation that has never been detected in a bacterial sample in the United States. Those features include a genomic signature that has previously been seen in patients in the UKAsia and a person in Nevada-called pen A60 allele. But genome analysis shows for the first time that it also exhibits complete resistance to three antibiotics and some resistance to three others. One of them is a last resort in the United States: an injectable cephalosporin antibiotic called ceftriaxone.
In 2020, CDC stated that doctors should only use ceftriaxone to fight gonorrhea because all other antibiotics have been used to fight infection has lost its effect. Fortunately, the substantial dose recommended by the CDC still worked for this patient. It also cured the second person, who the health ministry said was not related to the first and was carrying the same strain of the virus with the same resistance pattern. But for experts, that reduced susceptibility suggests that ceftriaxone may also be on the verge of being phased out.
“This situation is both a warning and an opportunity,” said Kathleen Roosevelt, director of the Massachusetts Department of STD Prevention and HIV Surveillance. at historic highs across the US. To try to limit that trend, her agency has issued guidance to every front-line healthcare professional in the state, requiring them to widely interview patients who test positive. .
