Gonorrhea Ahoy!

31. March 2009
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Currently gonococci undergo a fulminant increase of resistances against antibiotics. Within five years, the resistance rate against the agent fluoric quinolone multiplied by seven. Now Canadian authorities report alarming cases. Is gonorrhea coming into vogue again?

The city’s landmark couldn’t get much bigger: More than half a kilometer the CN Tower sticks out in the sky of Toronto in Canada. By far tinier but not less impressive is a completely different noteworthiness of the largest Canadian city in Ontario: The pathogen considered tamed at times, which causes gonorrhea Neisseria gonorrhoeae celebrates its brilliant comeback. In unprecedented speed and without any signs of slowing down, those of all strains of the bacterium many physicians not only in Canada have fought against over years with antibiotics of the quinolone class. As the February edition of the CMAJ documents impressively, the rates of resistance against the agent fluoric quinolone increased from 4% in 2001 to 28% in 2006.

As a matter of fact, the results of a study made at the reputed Toronto Hospital for Sick Children are frightening mainly for one reason: The multi-cultural metropolis is not only said to be the global gateway to Canada. The megacity also provides to a vast number of globetrotters and business tourists everything in regard to culture, music and last but no least – unprotected sexual intercourse. And exactly that emerges as problem no. one on the American continent – despite Aids and the related information campaigns. The publication of Susan Richardson at ”Sick Kids“, another name of the hospital where the physician works at, now reveals it. And: Heterosexual men with their preference of “rubber-free” love seem to support the undesirable triumphal procession of the bacillus.

Asia’s got it as well

It would inappropriate to doubt Richardson’s data since the physician used epidemiological records of the Public Health Laboratory at the national Ontario Agency for Health Protection and Promotion (OAHPP) in Toronto. Also the National Microbiology Laboratory (NML) in Winnipeg, an institution considered independent as well, supplied data. The fact that public institutions served as data suppliers for Richardson’s study is relevant for a very sensitive reason: Reams of studies are financed by large pharmaceutical companies to present own drugs favourably compared to those of the competitors. The plain fact that a whole class of an agent might not be usable in case of a suspected gonorrhea could very well hit one or the other manufacturer.

But it supplies physicians with the opportunity to react reasonably to the new threat. Since 2006, guidelines in Canada call for a stop of application of agents such as Ciprofloxacin or Ofloxacin due to the observed resistances for treatment of sexually transmitted diseases. According to John Tapsall at the Centre for Sexually Transmitted Diseases in Sidney/Australia, an institution which also cooperates with the WHO, similar problems occurred in Japan and Hong Kong with Cefixim and Cetriaxon.

Condoms instead of “Rubber-free”

Canadian officials therefore advise physicians to make a resistance test before therapy with antibiotics. But finding out which drug works against which pathogen often fails in practical life due to a lack of time – up to four days might pass before the physician knows which drug exactly the pathogens of his patient are not resistant to. Condoms remain the best protection against gonorrhea, as Richardson resumes. Once illuminated, the chances of improvement are not so bad after all.

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