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To the untrained eye, the press release issued by the Massachusetts Department of Public Health two weeks ago may appear rather anonymous. It was couched in language that was a little creepy, albeit carefully chosen: analysts had discovered a strain of gonorrhea which showed a “reduced response to several antibiotics“ in one patient, who was subsequently treated, however, together with another person with a similar infection.
To a civilian, the announcement can be compared to hitting a small wave on a boat: a moment of imbalance after which everything returns to normal. But for those involved in public health and medicine, the feeling was that of having sighted the iceberg aboard the Titanic.
The real message that was hidden inside the release was that an ancient and basic disease that we practically no longer think about – despite the fact that it affects only in the United States almost 700 thousand people every year – is developing a resistance against the latest antibiotics available to treat it. If gonorrhea manages to escape these drugs, our only options will be to desperately search for other as-yet-unapproved drugs or return to a time when untreated disease caused disabling arthritis, blinded infants, and led to to infertility due to testicular damage in men and pelvic inflammatory disease in women.
For the professionals, the most worrying aspect of the story is that they predicted the arrival of the iceberg. Gonorrhea is not like Covid-19, a new pathogen that has caught us by surprise necessitating heroic efforts in research and treatment. It’s a well known enemy, as old as the worldwith a predictable response to treatment and a predictable history of antibiotic resistance.
Nonetheless, the disease appears to be one step ahead of us. The Discovery Made in Massachusetts”it is alarming“, points out Yonatan Grad, physician and infectious disease researcher and associate professor at Harvard’s TH Chan School of Public Health, “it’s the affirmation of a trend we knew was happening. And the prediction is that the situation will get worse“.
Reduced options
The Massachusetts Department of Public Health said the patient named in the release was diagnosed with a new strain of gonorrhea that had a number of characteristics never before seen in a bacterial sample in the United States, including the allele penA60a genomic signature already found in patients in the UKin Asia and in a person in Nevada. However, the genomic analysis also revealed that the strain also had one for the first time resistence complete to three antibiotics and some resistance to three others. One of these is ceftriaxone, an injectable cephalosporin that is used as a drug of last resort in the United States.
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