Gonorrhea Defies An Antibiotic

Possible West Coast strain transported to NY is at root of health experts’ concern

“For some time we have been seeing increasing fluoroquinolone resistance in specific regions of the country,” said Dr. John Douglas, director of the CDC’s Division of STD Prevention, in an April 29 telephone press conference.

Data from 23 cities that are part of a CDC gonorrhea surveillance program found that all cases that were resistant to fluoroquinolones went from 0.4 percent in 2002 to 0.9 percent in 2003. Resistant cases among gay and bisexual men went from 1.8 percent in 2002 to 4.9 percent in 2003. Among heterosexual men with gonorrhea in the 23 cities just 0.4 percent of cases were resistant to fluoroquinolones.

Previously, the CDC told doctors to treat all gonorrhea cases with a single dose of an orally administered fluoroquinolone. That is still the treatment for gonorrhea among heterosexual men and women, but now gay and bisexual men with the bug should get a different antibiotic that is injected.

The resistant strain is a “rapidly emerging health concern for gay and bisexual men,” according to Douglas. It was likely that gay men who traveled to Hawaii and the West Coast, where the resistant strain has been seen previously, carried the infection home. “That’s a hypothesis, but it’s the most plausible one at this time,” Douglas said.

New York City is seeing an increase in the resistant strain among gay and bisexual men, according to Dr. Susan Blank, assistant commissioner of the city health department’s Bureau of Sexually Transmitted Disease Control. The health department reported 22 cases of fluoroquinolone-resistant gonorrhea in the first seven months of 2003 after seeing just eight infections in 2002 and three in 2001.

Among gay and bisexual men with gonorrhea, 12.5 percent had the resistant strain while, among “other men,” 1.6 percent of the cases were resistant as were 2.4 percent of the cases among women.

The resistant strain is nearly eight times more common among queer men than among straight men, though the lower number among “other men” may result from less testing of the gonorrhea strains among those men. “It’s not a sample of every single culture because we use it only when people tell us that they have had oral or anal exposure,” Blank said. “The sampling is sort of biased because most of the patients who report anal or oral sex are men who have sex with men.”

Blank said that doctors needed to be more careful in prescribing antibiotics generally and gay men needed to practice safe sex. “In general, the whole world needs to be careful about the use of antibiotics,” she said. “The other take- home message is safe sex, be careful, use latex barrier protection when you are going to have sex.”

A state health lab in Massachusetts reported that between January and August of 2003 it found fluoroquinolone-resistant gonorrhea in 11.1 percent of the samples from gay and bisexual men versus 1.8 percent of the samples taken from straight men.

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