New Multi-Drug Resistant Gonorrhea Detected In U.S., 2 Cases In Massachusetts

What’s worse than being told that you have gonorrhea? How about being told that you are the first case in the U.S. of gonorrhea that has either no response or reduced response to five different classes of antibiotics? Yep, that’s what recently happened to not one but two people in Massachusetts, according to a January 19 announcement from the Massachusetts Department of Public Health (DPH). They were infected with a strain of Neisseria gonorrhoeae bacteria that’s even harder to treat, which is kind of like getting kicked in the groin and then falling forwards groin-first on to a bowling ball. Think about the burning sensation that drug-resistant gonorrhea may give you the next time you are on a Tinder date and forego using condoms because “it feels better without a condom.”

An alert letter from the Centers for Disease Control and Prevention (CDC) to health professionals described how these cases were found. The first case went to a primary care clinic after experiencing urethritis symptoms. Urethritis, which is pronounced “your a thritis” as opposed to “we all are thritis,” is inflammation of your urethra. Your urethra is that tube that runs from your bladder to where pee comes out of your body. When you have such inflammation, you may feel the urge to urinate even when you don’t need to urinate. That’s called urinary urgency, which is a little different from the urgency you get when you are trying to sell your bitcoin before its price drops any further. Other possible signs of urethritis include difficulty starting urination, feeling itching, pain, or discomfort down there, or a discharge or blood coming out of your urethral opening.

The health professionals at the clinic took specimens from the patient’s urethra and then found N. gonorrhoeae in those specimens. The Massachusetts State Laboratory conducted further testing, which revealed that this bacteria was unusually resistant to different antibiotics, and then subsequently sent the samples to the CDC for even more testing. It turned that this N. gonorrhoeae had reduced susceptibility to ceftriaxone, cefixime and azithromycin and full resistance to ciprofloxacin, tetracycline, and penicillin. It was the first documented case in the U.S. of N. gonorrhoeae being at least partially resistant to six of the seven antibiotics typically tested as part of the standard GISP (Gonococcal Isolate Surveillance Project) panel. The reduced susceptibility to ceftriaxone seemed to be the result of a penA60 allele mutation.

Searching available samples from other patients in Massachusetts found this mutation to be present in N. gonorrhoeae from another patient, thus identifying the second case in the state. Fortunately, both cases of gonorrhea were only partially resistant to ceftriaxone, an antibiotic recommended by the CDC to treat gonorrhea. Therefore, doctors could successfully use ceftriaxone, specifically a single injection of ceftriaxone 500 mg intramuscularly, to get rid of the infections in both cases. Nevertheless, finding this new drug-resistant version of N. gonorrhoeae ain’t good news. The concern is that eventually this version of the bacteria may some day mutate to the point that none of the available antibiotics work.

Of note, these two cases didn’t seem to be related in any way, unless the two were playing the “Never saw that person in my life” game. Therefore, there could be other people quietly carrying this new multiple drug-resistant version of N. gonorrhoeae. Let’s hope that not too many people who indicate that they have a “growth mindset” on their dating profiles aren’t referring to the growth of N. gonorrhoeae.

The two cases in Massachusetts were actually the second and third times the penA60 allele has been found in the U.S. The first time was in Las Vegas, Nevada back in December 2019. Apparently, what happened in Las Vegas may not have stayed in Las Vegas. Although these have been the only three such cases detected in the U.S. to date, it’s not clear how far the bacteria has already spread as not everyone may have gotten tested. This version of N. gonorrhoeae with the penA60 allele has already appeared in the United Kingdom and parts of Asia so it may be only a matter of time before more cases appear elsewhere.

If you haven’t figured it out yet, gonorrhea is not a great sexually transmitted infection (STI) to have (as opposed to all of the other wonderful-to-have STIs, right?) You may not have any symptoms whatsoever, which means that you can silently, unknowingly spread the infection to other. When you do have symptoms, they typically abdominal or pelvic pain and symptoms of urethritis.

Now, before you say, “Who couldn’t use a little more urgency in life,” the even bigger with gonorrhea is the various complications that can occur. The bacteria can spread to other parts of your pelvis, leading to pelvic inflammatory disease, infertility, and pregnancy complications in women and inflammation of the epididymis, which is located in your testicles, and infertility in men. The bacteria can also spread to your joints, your bloodstream, and other parts of your body, resulting in all sorts of problems such as fever, rashes, sores, joint pain, swelling and stiffness. The bottom line (which by the way can be affected too) is that gonorrhea is a serious problem. So get tested for gonorrhea if you have had unprotected sex with anyone who hasn’t been a long term exclusive partner, even when you don’t have any symptoms.

What makes this an even more serious problem is the emergence of this new multi-drug-resistant version of gonorrhea in the U.S. The DPH announcement quoted Massachusetts Public Health Commissioner Margret Cooke, JD, as saying, “The discovery of this strain of gonorrhea is a serious public health concern which DPH, the CDC, and other health departments have been vigilant about detecting in the US.” She added, “We urge all sexually active people to be regularly tested for sexually transmitted infections and to consider reducing the number of their sexual partners and increasing their use of condoms when having sex.”

Yes, it may be a really good idea to reduce the number of sexual partners, especially if you need an app to keep track of them all. Gonorrhea has been on the rise throughout the U.S., with reported cases increasing by 131% from 2009 to 696,764 in 2021 according to data from the CDC. You definitely shouldn’t be resistant to the idea of using condoms during sex, lest you get something that’s resistant to a whole lot of antibiotics.