by To an unknown Eye the Massachusetts Department of Public Health press release two weeks ago looked pretty routine. His language was perhaps a little disconcerting, but he said it carefully: Analysts had spotted a resident with a strain of gonorrhea who showed “decreased response to multiple antibiotics,” but that person – and a second with a similar infection – had been cured.
To a civilian, the announcement may have felt like being nudged across a small wave in a boat: a moment of unbalance, then back to normal. For people in public health and medicine, it felt more like they were on the titanic and discover the iceberg.
Here’s what the news actually said: A disease so old and fundamental that we hardly think about it, even though it affects nearly 700,000 Americans every year, is overcoming the last antibiotics now available to treat it. If it gains the ability to evade those drugs, our only options will be a desperate search for others not yet approved — or a return to a time when untreated gonorrhea caused debilitating arthritis, blinded infants at birth, and Men rendered infertile by testicular damage and women by pelvic inflammatory disease.
The tiring thing for professionals is that they saw the iceberg coming. Gonorrhea is not like Covid, a new pathogen that caught us by surprise and required heroic research efforts and medical care. It’s a known enemy, as old as the record of history, with a predictable response to treatment and an equally predictable record of antibiotic resistance.
Nevertheless, it rushes ahead of us. The discovery in Massachusetts “is alarming,” says Yonatan Grad, an infectious disease physician and researcher and associate professor at Harvard TH Chan School of Public Health. “It’s a confirmation of a trend that we knew was happening. And the expectation is that it will only get worse.”
In a bit more detail about the announcement, the Massachusetts department said the individual had been diagnosed with a novel strain of gonorrhea, carrying a constellation of traits never before detected in a bacterial sample in the United States. These traits included a genomic signature — previously seen in patients in the UK, Asia, and one individual in Nevada — called the penA60 allele. However, genomic analyzes showed that it also showed complete resistance to three antibiotics and some resistance to three others for the first time. One of these is the drug of last choice in the US: an injectable cephalosporin antibiotic called ceftriaxone.
In 2020, the CDC stated that physicians should only administer ceftriaxone for gonorrhea because all other antibiotics historically used to treat the infection had lost their effectiveness. Fortunately, the substantial dose recommended by the CDC was still working in this patient. It also cured the second person, who the health department says has no connection to the first and carried the same strain with the same resistance pattern. But for experts, that reduced vulnerability suggested ceftriaxone might be on the way out, too.
“This situation is both a warning and an opportunity,” says Kathleen Roosevelt, director of the Department of STD Prevention and HIV Surveillance in Massachusetts, noting that rates of gonorrhea in the US have reached historic highs. To curb this trend, her agency has issued instructions to all frontline medical workers in the state, asking them to extensively interview patients who test positive and encourage those who have received treatment to come back to make sure they are cured are. and most importantly, change the way clinics test patients for infections from the start.
