Gonorrhea, now resistant to most drugs, on the rise in Maine

Posted Dec. 06, 2012, at 3:22 p.m.
Last modified Dec. 06, 2012, at 5:57 p.m.
Dr. Stephen Sears, Maine state epidemiologist
Dr. Stephen Sears, Maine state epidemiologist

An unusually high number of Mainers have been diagnosed this year with gonorrhea, a sexually transmitted disease that’s grown stubbornly resistant to treatment.

Through Oct. 31, Maine recorded 370 cases of gonorrhea, according to the Maine Center for Disease Control and Prevention. That’s a jump from 272 cases in all of last year and nearly four times the number of cases in 2008.

The incidence of gonorrhea has steadily risen in Maine over the last four years. It’s a troubling trend, coinciding with an ever-shrinking arsenal of drugs at doctors’ disposal to treat the increasingly drug-resistant disease.

Today, just one remaining antibiotic is reliably effective against the infection. Meanwhile, a “superbug” strain of gonorrhea that’s becoming untreatable has spread across Europe. One of the most common infectious diseases, gonorrhea is sounding public health alarms globally.

In 2012, most of the cases in Maine have arisen among those ages 20-29 in Cumberland, Androscoggin and York counties, particularly women, who are vulnerable to serious reproductive complications.

“We have noticed the uptick,” said Megan Hannan, Maine director of public affairs for Planned Parenthood of Northern New England.

Health care providers are required to report new cases of gonorrhea to health officials. The state CDC is exploring small pockets where the disease has spread to learn what factors correspond to higher risk this year, including race, gender and types of sexual partnerships.

“It’s not just Maine,” said state epidemiologist Dr. Stephen Sears. “There’s been an increase in sexually transmitted diseases in many parts of the country. I’m not sure if I know all of the reasons. Usually we find subpopulations that the disease is propagating in.”

In August, the federal Centers for Disease Control and Prevention issued new guidelines for how doctors should treat gonorrhea, scrambling to keep pace with the increasingly drug-resistant disease. The guidelines were an update to recommendations issued in 2010.

Caused by the Neisseria gonorrhoeae bacterium, gonorrhea was, for years, treated with common antibiotics including penicillin and tetracycline. Wide use of those drugs for a variety of infections, coupled with the rapid mutation of some strains, has over time rendered those antibiotics ineffective for warding off gonorrhea.

Now, officials recommend just one remaining drug proven effective against the disease, an injectable antibiotic called ceftriaxone. Another drug in the same class that formerly wiped out gonorrhea, the oral antibiotic cefixime, appears to be losing its potency.

The CDC’s new guidelines advise physicians to stop treating gonorrhea with cefixime as their first course of action. Doctors are now recommended to pair the injectable ceftriaxone with one of two other oral antibiotics before resorting to cefixime.

Health officials hope the new guidelines will stave off a time when gonorrhea can’t be treated with either ceftriaxone or cefixime.

“Around the country, [gonorrhea] has a notorious habit of becoming resistant to whatever we’re treating it with,” Sears said.

In men, common symptoms of gonorrhea include a burning sensation while urinating and discharge from the penis. In women, symptoms may be mild or nonspecific, and may include a painful or burning sensation when urinating or increased vaginal discharge.

Some people experience no symptoms at all and are unaware they have gonorrhea, boosting the risk of complications and of spreading the disease to others.

Women can suffer serious reproductive complications from gonorrhea, including inflammation of the Fallopian tubes that can lead to sterility and dangerous ectopic pregnancy, Sears said.

“We have seen more women, that’s been one of our concerns,” he said.

The infection can be spread by contact with the mouth, vagina, penis, or anus. It most commonly affects the genitals, but can also infect the eyes and throat.

Practicing safe sex can limit gonorrhea’s spread, Sears said.

“Using barrier protection is a good way to prevent exposure,” he said.

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