For Immediate Release
June 4, 2010

KDHE Office of Communications
communications@kdheks.gov, 785-296-0461

The Next Superbug: Coming Soon to a Community Like Yours?

An Op-Ed Column by Jason Eberhart-Phillips, MD
Kansas State Health Officer

Gonorrhea isn’t a topic that is usually brought up in polite company. But maybe it should be.

Today this age-old sexually transmitted infection is making a worrisome comeback after decades of decline. More than 336,000 cases were officially reported in the United States in 2008. The actual count was probably double that number.

Gonorrhea rates in Kansas have mirrored the national trend. After bottoming out in 2006, rates here in 2009 jumped by 10 percent from the previous year.

Gonorrhea can cause many uncomfortable symptoms, but often these infections aren’t noticed at all. That’s a problem because when gonorrhea is left untreated, it increases a person’s risk of HIV infection. Untreated gonorrhea is also a leading cause of infertility.

That’s why it is so important for sexually active adults, particularly young women, to be screened for gonorrhea and other common sexually transmitted infections as part of their routine medical care. When screening tests are positive for infection, certain antibiotics can stop gonorrhea dead in its tracks and lower the risk of serious complications.

But the days of easy treatment for gonorrhea may soon be coming to an end. Growing resistance to antibiotics is giving doctors fewer and fewer choices in treating gonorrhea.

And we may be on the verge of running out of treatments altogether.

Time and again, the bacteria that cause this disease have found a way to evade medicine’s best antibiotic weapons. In the 1930s and 1940s, these bacteria steadily developed resistance to sulfa drugs, the first class of antibiotics, before doctors found they could treat cases easily with the new miracle drug penicillin.

Over time, ever-increasing doses of penicillin were needed to attain a cure, until by the mid-1980s penicillin resistance had become so common that the drug was rendered useless. Fluoroquinilones such as Cipro next filled the need for effective treatment, but eventually new strains of drug-resistant gonorrhea knocked out these agents too.

Today just a single class of antibiotics remains available for the treatment of gonorrhea, certain compounds of the cephalosporin group. Worse still, there is almost nothing else being developed in the pharmaceutical pipeline that might be used to treat the disease in the future if, or when, the cephalosporins start to fail.

Cases of gonorrhea needing higher doses of cephalosporins have already started turning up in Japan, Hong Kong and elsewhere, causing some public health experts to worry that an incurable, super-resistant strain may be just around the corner.
A world without a cure for gonorrhea would be a dangerous place to live.

Our best hope to avert this catastrophe is to put a lid on the rising incidence of the disease today with some old-fashioned case-finding, targeted treatment of sexual contacts, and frank public education about abstinence, fidelity and using condoms to reduce the risk of exposure.

This important work requires renewed public investment in a specialized public health workforce, including locally placed disease investigators who track down infected people and ensure they receive adequate treatment and education. A couple dozen such dedicated people are now working in Kansas, but we need many more.

The looming crisis also demands that schools, faith communities, businesses and other community organizations work together to shatter the polite silence about gonorrhea and other sexually transmitted infections, by promoting public awareness, supporting testing and treatment, and encouraging responsible sexual behavior for everyone.

The control and eventual elimination of gonorrhea requires more than effective drugs. It requires leaders in every sector willing to talk about it, and a public willing to listen and act.

Dr. Eberhart-Phillips is the Kansas State Health Officer and Director of Health in the Kansas Department of Health and Environment. He can be reached at jeberhart-phillips@kdheks.gov. Previous columns are now available online at Dr. Jason’s Blog, www.kdheks.gov/blogs/dr_jasons_blogs.htm.