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The last drug able to fight gonorrhea begins to weaken

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gonorrhea begins to weaken

To a stranger Eye, the press release from the Massachusetts Department of Public Health two weeks ago seemed rather routine. His language was perhaps a bit unnerving, but carefully worded: analysts had found a resident with a strain of gonorrhea who had a “reduced response to multiple antibiotics”, but this person – and a second with a similar infection – had been cured.

For a civilian, the announcement might have felt like hitting a small wave in a boat: a moment of imbalance, then back to normal. For people in public health and medicine, it was more like being on the Titanic and spot the iceberg.

Here’s what the news really said: A disease so old and basic that we hardly think about it, even though it affects nearly 700,000 Americans a year, is beating the last antibiotics now available to treat it. If he gains the ability to evade these drugs, our only options will be a desperate search for others that are not yet approved – or a return to a time when untreated gonorrhea caused crippling arthritis, blinded infants at birth and rendered men sterile. by damage to the testicles and women by pelvic inflammatory disease.

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What is boring for professionals is that they saw the iceberg coming. Gonorrhea is not like Covid, a new pathogen that took us by surprise and required heroic research efforts and medical care. It is a well-known enemy, as old as recorded history, with a predictable response to treatment and an equally predictable record of acquiring antibiotic resistance.

Nevertheless, it is ahead of us. The Massachusetts discovery “is alarming,” says Yonatan Grad, an infectious disease physician and researcher and associate professor at Harvard TH Chan School of Public Health. “It’s an affirmation of a trend that we knew was happening. And we expect it to get worse.

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A few more details about the announcement: The Massachusetts department said the person had been diagnosed with a new strain of gonorrhea that carried a constellation of traits never before detected in a bacterial sample in the United States. These traits included a genomic signature – already seen in patients in the UK, Asia and one person in Nevada – called the Pen A60 allele. But genomic analysis showed that it also showed, for the first time, total resistance to three antibiotics and some resistance to three others. One is the drug of last resort in the United States: an injectable cephalosporin antibiotic called ceftriaxone.

In 2020, the CDC said doctors should only give ceftriaxone for gonorrhea because all other antibiotics historically used for the infection had lost their effectiveness. Fortunately, the substantial dose recommended by the CDC still worked for this patient. It also cured the second person, who the health department says is unrelated to the first and carried the same strain with the same resistance pattern. But for the experts, this reduced sensitivity indicated that ceftriaxone could also be on its way out.

“This situation is both a warning and an opportunity,” says Kathleen Roosevelt, director of Massachusetts’ Division of STD Prevention and HIV Surveillance, noting that gonorrhea rates are reaching historic highs in the United States. . In an attempt to curb this trend, his agency has issued instructions to all frontline medical professionals in the state, asking them to extensively interview patients who test positive, encourage those who have received a treatment to come back to make sure they’re cured…and, most importantly, change the way clinics test patients for infection to begin with.

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