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Drug-resistant gonorrhea spreading rapidly in U.S.

Changes in treatment are recommended to combat the increase.

April 13, 2007|Jia-Rui Chong | Times Staff Writer

Highly drug-resistant gonorrhea has been spreading rapidly across the U.S. and accounts for 13% of all cases of the sexually transmitted disease, federal researchers said Thursday.

In a survey of 26 areas around the country, the Centers for Disease Control and Prevention found particularly high rates of drug-resistance in Long Beach, Orange County, San Diego, San Francisco, Philadelphia and Honolulu. Drug-resistant infections accounted for at least 25% of all cases in those areas.

"That's a really dramatic trajectory in terms of emerging resistance," said Dr. John M. Douglas Jr., director of the CDC's Division of Sexually Transmitted Disease Prevention.

The CDC on Thursday urged doctors to stop using a powerful class of antibiotics -- fluoroquinolones -- that has been the primary treatment for the disease in most parts of the country.

The agency now recommends a single class of antibiotics known as cephalosporins.

"We have a very efficient class of drugs left, but if they go away and resistance marches on to other antibiotics, then we're really in trouble," Douglas said.

Gonorrhea, caused by the bacterium Neisseria gonorrhoeae, is the second most commonly reported infectious disease in the U.S., after chlamydia. There are an estimated 700,000 new cases each year.

The disease can lead to severe complications in women, including infertility. It also increases the risk of acquiring other sexually transmitted diseases, such as HIV.

It can be treated with antibiotics, but the bacterium has been developing resistance since the first drugs to fight it were introduced in the 1930s.

The CDC began recommending fluoroquinolones in 1993. Around 2000, fluoroquinolone-resistant gonorrhea began emerging in Hawaii and California.

Health officials believe it originated in East and Southeast Asia and spread through the U.S., first among gay men and then heterosexuals.

Hawaii and California soon asked doctors to stop using fluoroquinolones, but drug-resistant forms of the disease continued to spread across the country.

The CDC reported that 1% of gonorrhea cases in 2001 were of the highly drug-resistant version. After five years, that rose to 13% nationally.

The acceleration in drug resistance has been most striking in Philadelphia. The percentage of highly resistant gonorrhea cases skyrocketed from 1.2% in 2004 to 26.6% in 2006.

Among gay men, drug-resistant gonorrhea accounted for 38% of all cases, rising from just 1.6% in 2001.

The major West Coast cities had significant rates of drugresistant gonorrhea, but one anomaly has been Los Angeles, where the proportion remained stable around 10%.

Dr. Jonathan Fielding, the public health director for Los Angeles County, said he wasn't sure why Los Angeles had such relatively low rates but said it was possible that L.A. caught the drug-resistance problem fairly early and changed treatments.

But in California as a whole, clamping down on drugs has not had an immediate effect.

The rate of drug resistance continued to rise after the state advised against fluoroquinolones in 2002, more than doubling to 25% of all gonorrhea cases in 2005.

Dr. Gail Bolan, chief of the STD control branch at the state Department of Health Services, said she was not sure how many years it would take before the state saw a reduction.

"Unfortunately, we don't understand the organism well enough," she said.

jia-rui.chong@latimes.com

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