‘Supergonorrhea’ arrives in the USA: what is known about the disease

Two cases of a strain of gonorrhea known to be less sensitive to the action of different antibiotics have been detected in Massachusetts, the United States, the US Department of Public Health announced on Monday.

According to the agency, this new strain had previously been found in the UK and Asia-Pacific countries, but these are the first cases discovered in the United States.

  • The identification of the strain was described by Public Health Commissioner Margret Cooke in an official statement as a “major public health problem” in the United States.
  • To date, no direct link has been found between the two people who were diagnosed.
  • Now, agency epidemiologists are focused on monitoring other people who may have acquired the resistant strain.
  • The infection is transmitted during vaginal, anal or oral sex with someone who is infected. Even pregnant women who have gonorrhea can infect their baby.

Live well he spoke with infectious disease specialist Rico Vasconcelos, a researcher at the USP School of Medicine and a specialist in STIs (Sexually Transmitted Infections), to answer questions about the strain. Look down.

It’s not a new strain, as it was already found in Asia in 2021 and 2022, and it was found in the UK, but this is the first time this strain has been found in the US and the Americas, so you can see which is a variety that is spreading all over the world. Rico Vasconcelos, infectious disease specialist and physician at HCFMUSP.

1. Why is the strain called “supergonorrhea”?

  • Gonorrhea is a sexually transmitted infection caused by bacteria Neisseria gonorrhoeae and is considered the second most common bacterial STI in the world.
  • In Brazil, the Ministry of Health estimates around 500,000 new cases a year.

The resistance of gonorrhea to available antibiotics for treatment has increased in recent years, according to the WHO. This means that the bacterium is less sensitive to the drugs used to fight it.

In the US, both patients were successfully treated with ceftriaxone, the drug currently used to treat the disease, but had a reduced response to several antibiotics, prompting US media to dub the strain “supergonorrhea”.

Part of the media is giving this name because the strain is losing sensitivity to this antibiotic and, if one day it loses it completely, it will become resistant to the drug. This doesn’t mean that there won’t be possible antibiotics to cure the infection, there are others. But, if that happens, we’ll lose another bullet from our arsenal, which is why there’s this concern. Rico Vasconcelos, infectious disease specialist and VivaBem columnist.

2. Why is gonorrhea becoming resistant to antibiotics?

Some of the factors cited by WHO to explain the increase in gonorrhea resistance to antibiotics are:

  • Unlimited access to antibiotics;
  • Inadequate selection and overuse of antibiotics;
  • Low quality antibiotics.

The currently recommended treatment for gonorrhea is a combination of the drugs ceftriaxone and azithromycin.

However, Vasconcelos explains, doctors in different regions of the world, including Brazil, are still prescribing the wrong antibiotics to treat the infection, using old options that have lost their effectiveness.

“A bacterium doesn’t become resistant to antibiotics unless it is exposed to an antibiotic in the wrong dose, at the wrong time, in the wrong way. When you treat the bacterium with the wrong antibiotic, you give it the ability to select for resistant strains” , explains the doctor.

“So there’s also a bit of irresponsibility on the part of healthcare professionals who are taking the wrong approach to these cases,” he says.

  • Another factor that favors the resistance of the bacterium to antibiotics is the lack of tracking of people who have had contact with individuals infected with gonorrhea.
  • This is because the disease can be asymptomatic and, in these cases, the individual, in addition to infecting other people, favors the survival and mutation of the bacterium.

3. Are there any risks for Brazil?

“Risk is always there, because there’s a very large flow of people into the world,” Rico says. Covid-19 and the monkeypox epidemic in 2022, adds the infectologist, are proof of how an infection can spread rapidly around the world.

However, so far, there is no record of super resistant gonorrhea in Brazil.

In general, the recommendation of the Ministry of Health is to contact the public health service in the presence of symptoms (see at the end of the text). The treatment offered is free and should also be extended to sexual partners.

4. Recommendations to prevent bacteria from becoming super resistant

Prescribing antibiotics by doctors in the correct way (type, dosage and duration of use) and monitoring STIs are two key actions to prevent bacteria from becoming resistant to antibiotics worldwide.

“Unfortunately, here in Brazil we are getting it all wrong, because there is no STI screening among people with an active sex life. When screening is done, it is done for HIV and syphilis, because the gonorrhea test and of chlamydia is not widely available in the country Brazil”, assesses the infectious disease specialist.

The result, he says, is that many people can carry the bacterium without showing symptoms and, therefore, transmit it without knowing it, favoring mutations in the microorganism.

We can’t imagine that one day it would be possible to tell people to stop having sex, because that’s no way to control the spread of resistant strains. Proper control is done by screening and proper treatment.

  • In the United States, a notice has been issued to doctors and laboratories to strengthen infection awareness policies.
  • The recommendation is to increase testing in symptomatic people and to use high doses of ceftriaxone in the treatment of patients.
  • “We urge all sexually active people to get tested regularly for STDs and to consider reducing the number of sexual partners and increasing condom use,” added health worker Margret Cooke.

Look at the symptoms of gonorrhea

in women

In 60-70% of women there are no symptoms. Often the person only becomes aware of the disease when the partner is diagnosed. Although they are rare, the following signs may be seen in women:

  • Urgent need to urinate
  • pain when urinating
  • Vaginal secretion
  • Pain during sexual intercourse
  • Temperature

Symptoms of infection in men

Among men, the signs usually appear between two and seven days after infection. See what they are:

  • pain when urinating
  • Purulent discharge (may be white, yellow or green).

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