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Health officials have long warned that gonorrhea is becoming resistant to all the antibiotics we need to fight it. Last year, the U. S. reached a grim milestone: For the first time, two unrelated people in Massachusetts were diagnosed with gonorrhea infections with complete or reduced susceptibility to all the drugs in our arsenal, adding the first-line drug, ceftriaxone. Fortunately, they were still cured with high-dose injections of ceftriaxone. But, as the U. S. Centers for Disease Control and Prevention puts it bluntly, the U. S. Centers for Disease Control and Prevention (CDC) has been a key factor in the development of the disease. According to the U. S. Department of Health, “Little separates us from incurable gonorrhea anymore. “
While those single-digit percentages may seem low compared to other countries, they are incredibly high. In the U. S. , for example, the prevalence of ceftriaxone-resistant strains never exceeded 0. 2% between 2017 and 2021, according to the CDC. In Canada, ceftriaxone resistance remained at 0. 6% between 2017 and 2021. The UK had a prevalence of 0. 21% in 2022.
Lately, ceftriaxone is the first-line remedy for gonorrhea, as Neisseria gonorrhoeae has spent the last few decades developing resistance to just about everything else. As the CDC notes, in the 1980s, the drugs of choice for gonorrhea infections were penicillin and tetracycline. But the bacteria have developed resistance. In the 1990s, the CDC was forced to switch to a series of antibiotics called fluoroquinolones, adding ciprofloxacin (Cipro). But resistance to fluoroquinolones has also evolved, and resistance to Cipro is now widespread. In the early 2000s, the CDC began wanting to modify its recommendations as resistance spread to new places and populations.
In 2007, the company switched to cephalosporins and added cefixime. In 2010, the CDC again updated the remedy, recommending that doctors mix cephalosporins with one of two other types of antibiotics (azithromycin or doxycycline) in an attempt to thwart the progression of the disease. resistance. But that, too, was useless. Two years later, in 2012, the CDC updated its recommendations when resistance to cefixime developed. In 2020, azithromycin was also discontinued. Cephalosporin, ceftriaxone, is the newest drug available in the United States to treat gonorrhea infections.
In China, the immediate spread of ceftriaxone-resistant strains is alarming. The data comes from 2,804 strains, accounting for 2. 9% of all cases reported in China in 2022. These figures come from thirteen of the country’s 19 provinces. While the overall prevalence of ceftriaxone-resistant isolates was 8. 1% among the 2,804 isolates, five of those thirteen provinces had prevalence rates above 10%. Three provinces had prevalence rates above 25%. A total of 18 isolates were resistant to all antibiotics tested. with the exception of an outdated antibiotic called spectinomycin, which is discontinued in the United States and elsewhere.
The study has limitations. For one thing, the reported number of gonorrhea cases is probably underestimated compared to actual cases. Beyond the gaps in reporting, many other people with gonorrhea have no symptoms and therefore do not seek treatment. In addition, isolates from researchers accounted for less than 3% of reported cases. Therefore, prevalence rates would not possibly constitute isolates to the country as a whole. In addition, the researchers did not have detailed knowledge of the cases that could also help identify specific threat points to develop resistance. , such as the antibiotics that patients were receiving. The authors noted that antibiotics can only be purchased by prescription in China.
“These findings underscore the pressing need for a comprehensive technique to combat N. antibiotic-resistant gonorrhoeae in China, adding the identity of the points contributing to this maximum rate of resistance, in provinces where the percentage of ceftriaxone-resistant gonococcal isolates is> 10 percent. The authors write.
But they also point out that this is not only an alarming situation for China, but also an “urgent public health issue” for the entire world. “These resistant clones have spread around the world and cross-border collaborative efforts will be imperative. to monitor and mitigate its spread,” they write.
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