- (HealthDayNews) -- New drug-resistant strains of gonorrhea
are popping up from Massachusetts to Hawaii, raising the possibility that
doctors will have to radically change their approach to a disease that
strikes an estimated 650,000 Americans each year.
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- If the strains become more common, sexually transmitted
disease clinics may have to return to the days when gonorrhea patients
needed injections instead of single doses of oral antibiotics such as Cipro.
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- Such a scenario "would create significant inconvenience
and increase costs in the systems and risks [from needle sticks] to health-care
personnel," says Dr. David H. Martin, director of the Louisiana STD
Research Center and chief of the infectious diseases division at the Louisiana
State University Medical Center.
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- Gonorrhea is one of the most common sexually transmitted
diseases, perhaps best known for its symptoms in men of burning and discharge
from the penis. While its symptoms may be less noticeable in women, gonorrhea
can hit them harder by causing pelvic inflammatory disease. In both sexes,
untreated gonorrhea can spread infection to the blood and joints, in addition
to making HIV easier to transmit.
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- Doctors have considered Cipro and its sister drugs to
be the best treatments for gonorrhea. But then the disease began to mutate
into new forms that are immune to the drugs.
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- The first cases of Cipro-resistant gonorrhea appeared
in Hawaii, Asia and islands in the Pacific as early as 2000, according
to the U.S. Centers for Disease Control and Prevention (CDC). The strains,
which are immune to Cipro and its sister drugs, subsequently spread to
California.
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- In a new report, the CDC announced that drug-resistant
strains have begun appearing elsewhere in the United States. In late 2002
and early this year, researchers noticed the strains showed up in patients
who had not visited Hawaii, California or Asia, where they could have been
infected or had sex with partners who had.
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- The CDC is warning the strains have appeared in New York
City, Washington state, Massachusetts, Michigan and Indiana. Officials
are advising doctors in Hawaii, California, Massachusetts and parts of
Michigan to stop or monitor their use of Cipro and its sister drugs, known
as fluoroquinolones.
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- Instead of taking Cipro in pill form, patients can turn
to injections of a drug known as ceftriaxone. But injections are dangerous
for nurses because gonorrhea patients are often infected with blood-borne
diseases such as HIV and hepatitis B and C, Martin says.
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- Also, it takes more time for nurses to give injections
than simply hand out pills, he says: "In a busy clinic, it would limit
the number of patients who could be seen in a day."
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- A return to injections would also make it impossible
for doctors to send patients home with pills for their infected partners,
who might otherwise never come to a clinic, says Dr. Thomas Farley, chairman
of the Department of Community Health Sciences at Tulane University School
of Public Health and Tropical Medicine. "It won't ruin gonorrhea efforts,
but it would make them a lot more difficult."
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- The good news is the injection drug ceftriaxone will
still quickly and effectively kill the disease in patients, Martin says.
"It's not like the end of the world in terms of not having anything
to treat gonorrhea."
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- In fact, doctors have plenty of experience in coping
with the changing face of gonorrhea. In the 1970s and 1980s, strains of
the infection became immune to the antibiotic penicillin, and doctors had
to search for alternatives.
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- In 1988, doctors turned to two oral drugs -- Cipro and
cefixime, a drug known by the brand name Suprax. Patients no longer had
to get two injections of penicillin in the buttocks or take more than a
week's worth of pills.
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- "These drugs made it possible for nurses in clinics
to treat patients on the spot, without injections, and make sure they got
effective treatment, rather than relying on the patients to take (or often,
forget to take) seven to 10 days of pills," Farley says.
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- But the manufacturer of Suprax no longer makes the drug.
And the disease itself may be taking Cipro out of the picture.
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