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UMass Chan researchers explain risk of spread in novel gonorrhea strain

Two cases of a multidrug non-susceptible strain of gonorrhea detected in Massachusetts in January

A novel strain of gonorrhea was identified in Massachusetts last month and UMass Chan Medical School infectious disease researchers say testing and surveillance is critical for reducing spread.

Sanjay Ram, MD

“The strain’s history shows that it will spread quickly,” said Sanjay Ram, MD, professor of medicine in the Division of Infectious Diseases and Immunology.

Two cases of the multidrug-non-susceptible Neisseria gonorrhoeae were detected on Jan. 19 in Massachusetts, both of which were cured with ceftriaxone, the only antibiotic recommended to treat gonorrhea. The cases mark the first time in the U.S. of resistance or reduced response to five classes of antibiotics for gonorrhea. According to the Massachusetts Department of Public Health, it is the same strain identified in the United Kingdom early last year, originally identified in Japan, which then spread to other countries in the Asia-Pacific region.

The Department of Public Health issued an alert to clinicians and laboratories to raise awareness of the new strain and to recommend an increased use of laboratory culture testing for patients with symptoms of gonorrhea.

Dr. Ram said ceftriaxone is widely available but it is not known how long it will be effective. That’s why it is important for clinics to perform cultures and antimicrobial susceptibility testing on patients and identify and screen asymptomatic patients to treat the gonorrhea and stop the spread of the new strain.

“The strain might accumulate more resistance mutations as it goes along, which is a huge problem with this bug. And I think this is a scary path, because all five classes of it were resistant to six of the seven antibiotics tested,” said Ram. “Fortunately, with the newly recommended dose of 500 milligrams of ceftriaxone, this patient was treated.”

Peter Rice, MD

According to Dr. Rice, one of the major reasons the U.S. is susceptible to an outbreak of the new strain of gonorrhea is lack of surveillance.

“The problem is that in the U.S., we don’t use cultures routinely anymore. So, these two cases in Massachusetts were isolated and identified somewhat serendipitously, because the two doctors decided to obtain cultures,” Rice said. “And I would say roughly 95 percent of the time, clinics have abandoned doing cultures. I applaud the doctors who managed to get specimens over to the lab.”

The Department of Public Health is asking clinicians to get cultures on every symptomatic patient, retest patients 14 days after treatment to ensure cure and again at three months for reinfection.

According to the CDC, gonorrhea is one of the five most urgent antibiotic resistance threats and can cause ectopic pregnancy, infertility and in rare instances, bloodstream infection. Since reaching a historic low in 2009, the number of cases of gonorrhea in the U.S. has risen more than 131 percent to 696,764 cases in 2021, according to preliminary data from the CDC. Gonorrhea was the second most common sexually transmitted infections among infections requiring mandatory public health reporting in the U.S. in 2020.

In Massachusetts, confirmed cases of gonorrhea have increased by 321 percent, from 1,976 cases in 2009 to 8,133 in 2021.

Rice and Ram stressed that combating the growing threat of gonorrhea requires patients being forthcoming with their physicians about their sexual history and using condoms, especially by those in high-risk groups, including teenagers and young adults.

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