The announcement of the DSP (Department of Public Health) of the state of Massachusetts (USA) about two cases of gonorrhea with resistance or reduced response to antibiotics left the country and international health authorities on alert in the last week.
The problem has been a concern for physicians for many years and seems to be becoming a reality.
Gonorrhea is the second most common STI (sexually transmitted infection) in the United States, second only to chlamydia, and the failure of traditional antibiotics to treat it can cause super gonorrhea to spread.
“This is the first time resistance or reduced response to five classes of antibiotics has been identified in gonorrhea in the United States. […] Overall, these cases are an important reminder that gonorrhea strains in the US are becoming less responsive to a limited arsenal of antibiotics.”
The strain of bacteria Neisseria gonorrhoeae identified in the US and had recently been reported in the UK and Asia.
It is not a more severe disease, with more exacerbated symptoms (see below), but a disease that, in theory, could last much longer.
Although the first patient was successfully treated with an intramuscular injection of the antibiotic ceftriaxone 500 mg, the team submitted the sample to laboratory analysis.
It was then that it was discovered that the bacterium was resistant to cephalosporins (ceftriaxone, cefixime, cefoxitin) and azithromycin, in addition to ciprofloxacin, penicillin and tetracycline, antibiotics commonly used in the treatment of gonorrhea.
The CDC (United States Centers for Disease Control and Prevention) recommends high doses of ceftriaxone in all cases of gonorrhea.
The second case was identified through surveillance. According to the health agency “based on its genome, it probably reduced in a similar way [ao primeiro caso] susceptibility to ceftriaxone and cefixime”.
“The emergence of this strain indicates the continued evolution of N. gonorrhoeae and the ability to develop resistance to antimicrobial treatment”, complements the DSP.
The CDC notes on its website that “gonorrhea has progressively developed resistance to the antibiotics prescribed to treat it.”
As antibiotics in the cephalosporin class are currently the most effective against cephalosporin strains, the emergence of new resistant mutations “would significantly complicate providers’ ability to successfully treat gonorrhea, as we have few simple, well-studied antibiotic options.” , well-tolerated, and highly effective,” the CDC notes.
“The discovery of this strain of gonorrhea is a serious public health concern that DPH, the CDC and other health departments have been vigilant to detect in the US,” Massachusetts Public Health Commissioner Margret Cooke said in a statement.
The WHO (World Health Organization) makes frequent warnings about the inappropriate use of antibiotics, which is the phenomenon responsible for antimicrobial resistance.
In 2014, a report by the entity stated that in poor countries, the administered doses are very small, and in rich countries, the use is excessive.
The document listed seven bacteria with the potential to become resistant. They are responsible for serious illnesses such as blood infections, diarrhea, pneumonia, urinary infections and gonorrhea.
Gonorrhea
Gonorrhea is transmitted during sexual intercourse, including oral sex, and can cause infection of the genitals, rectum and throat.
The main symptoms in women, according to the CDC, include:
• Painful or burning sensation when peeing
• Increased vaginal discharge
• Vaginal bleeding between periods.
In men, signs that suggest infection are:
• Burning sensation when peeing
• Whitish, yellow, or green discharge from the penis
• Sore or swollen testicles (less common)
Other symptoms can affect both men and women:
• Anal itching
• Dor
• Bleeding
• Painful bowel movements
In rare cases, gonorrhea can become a disseminated gonococcal infection (arthritis-dermatitis syndrome).
“It occurs when the infection spreads through the bloodstream to other parts of the body, especially the skin and joints. The joints become swollen, tender to the touch and extremely painful and have limited mobility. The skin over infected joints may become red and warm. People typically have a fever, feel generally ill, and develop arthritis in one or more joints,” describes the MSD Manual of Diagnosis and Treatment.
Patients may also have small red spots on the skin, usually on the arms and legs, which are slightly painful and may be filled with pus.
“Infections of the joints, bloodstream and heart can be treated, but recovery from arthritis can be slow,” adds the medical guide.
Using a condom during sexual intercourse is one of the measures that can help prevent gonorrhea.
In addition, tracking sexual partners after the diagnosis of the disease is essential to end the chain of transmission of the bacteria.
