Resistance Leads to Fewer Options for Treating STD
A rise in a drug-resistant form of gonorrhea in California is forcing health officials to turn away from a widely used, inexpensive antibiotic treatment, further narrowing their options to fight the sexually transmitted disease.
Officials say they are finding an increased number of gonorrhea infections that are resistant to the fluoroquinolone class of antibiotics, which includes Cipro. Gonorrhea, considered a “smart” bacteria, long ago developed mechanisms to resist other antibiotics, including penicillin.
Antibiotic resistance is a growing concern across the nation because doctors have fewer options when germs or bacteria develop ways to evade drugs.
Health officials in San Francisco and San Diego have already advised doctors to avoid Cipro and similar antibiotics in treating gonorrhea.
Instead, they have recommended cephalosporins, the last known class of antibiotics proven to treat the disease without resistance. Those drugs typically cost more per pill and sometimes must be injected.
The increased level of resistance, which has taken hold in the last year, is most common in gay and bisexual men, as well as people who have had sexual partners from Asia, where this resistance is now widespread.
Health officials from across California are meeting this week at the National STD Prevention Conference in San Diego, where they will discuss whether to rewrite treatment recommendations for all doctors in the state.
“We’re losing our ability to treat this infection if we’re left with one type of antibiotic that can be used,” said Dr. Gail Bolan, chief of the Sexually Transmitted Disease Control Branch at the California Department of Health Services.
Federal health officials are also worried because about 650,000 new cases of gonorrhea occur each year in the United States. The most common symptoms include discharge from the sexual organs and painful or difficult urination.
Four percent of gonorrhea cases--16 of 369--studied in Southern California in the last six months of 2001 were resistant to Cipro and other fluoroquinolones, officials say. While this number may seem small, it is significant because gonorrhea readily acquires resistance, and doctors can’t easily tell which patients have a resistant form.
“Once it’s above a couple percent, you would want to change your prescribing pattern,” said Dr. Stuart Berman, who monitors STD cases for the Centers for Disease Control and Prevention in Atlanta.
Los Angeles County officials say they are monitoring the situation but have not abandoned Cipro.
“It concerns me every time we lose antibiotics in our cornucopia. It’s not necessarily surprising--[gonorrhea is] the one organism that doctors know will quickly become resistant to antibiotics,” said Dr. Jeffrey Klausner, director of sexually transmitted disease control in San Francisco.
Berman said officials are not certain how many cases of drug-resistant gonorrhea exist in the country because few clinics test for such resistance. “We’re blind in a lot of areas of the country, just when it appears we’ll need that information to make appropriate clinical decisions,” he said.
While officials are primarily concerned about gonorrhea resistance, they also are becoming worried about signs of resistant forms of trichomoniasis, a parasite, and chlamydia, a bacterium, both of which are transmitted sexually.
