The Problem with Clap in the Yap — A Valentines Day Post

Feb 12 2014 :: Published in Infectious Diseases

By anonymous, NAAT-savvy laboratory scientist

The Problem with Clap in the Yap -- A Valentines Day Post | www.aphlblog.org

Valentine’s Day is typically a time to express heartfelt wishes to loved ones and close friends. The preceding days are the busiest for florists as sales spike from people who are programmed to translate botanic gifts into signals of love. If these gifts and unspoken intentions are accepted, sexual advancement may start with a kiss and end with a variety of infectious sensations—some perhaps a little more nefarious than others. Gonorrhea, anyone?

Gonorrhea is the second most common notifiable communicable disease in the US right behind chlamydia, the ubiquitous love bug. Many of the colloquial terms of gonorrhea, such as GC (Gentlemen’s Complaint), clap, dripsy and morning dewdrop were derived from symptomatic infection in the male reproductive tract. Transmission requires some form of insertive behavior since gonorrhea does not remain viable for extended periods outside of human bodies. However, gonorrhea does not discriminate between anatomic sites and will infect non-genital mucosa (including one’s oral cavity) as well as genital mucosa.

Getting clap in the yap may not seem like a big deal since it’s not associated with any colloquialisms, but there are risks for disease and transmission.  While most infections are asymptomatic, one study showed that sore throats were reported in 15% of patients that had an oropharyngeal gonococcal infection and purulent tonsillitis was observed in 5%. Laboratory diagnosis of gonorrhea in the oropharynx can be made by traditional methods of culture isolation and biochemical identification. However, most public health laboratories have abandoned these procedures  with the use of nucleic acid amplification tests (NAATs) replacing culture as the primary laboratory test since NAATs can detect the organism in a wider range of clinical specimens independent of viability. However, the use of NAATs is complicated since they are not cleared by the FDA for specimens collected from non-genital anatomic sites and laboratories need to perform an off-label verification study to satisfy CLIA requirements. Some but not all commercially available NAATs may cross-react with non-gonococcal Neisseria species and these commensals are typically found in a higher numbers in the oropharynx. Even though NAATs are not FDA cleared for non-genital tract specimens and some may yield a false-positive result, APHL published a report that was developed from a meeting with CDC and laboratory experts recommending the use of NAATs to detect chlamydia and gonorrhea from rectal and oropharyngeal specimens.

Luckily, gonorrhea is a treatable disease.  Current CDC treatment recommendations are available at http://www.cdc.gov/std/treatment. However, even though it’s treatable today, gonorrhea has developed resistance to several antibiotics over time after acquiring a gene from another bacteria species.

Gonorrhea loves to hook-up with other bacteria and the oropharynx may be analogous to a bacterial brothel for genetic sharing. If oropharyngeal gonorrhea isn’t treated quickly and correctly, there is an increased chance of developing new drug resistance and infections requiring protracted therapy. Though ceftriaxone resistant gonorrhea has not been detected in the US, the first case was found in the throat of a woman in Japan.

The adage that ‘no money, no honey’ has been drilled into people at Valentine’s Day may be difficult to change. Flowers are the primary choice for mental lubrication, but other options exist such as plays and shows.  However, if any involve clowns, be certain that none are named “Dripsy.”

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Hawaii’s Unique Public Health Challenges: Antibiotic Resistant Gonorrhea

Apr 18 2012 :: Published in Infectious Diseases

By Caitlin Saucier, CDC/APHL Emerging Infectious Diseases Laboratory Training Fellow, State Laboratories Division, Hawaii Department of Health

In honor of STD Awareness Month, I’d like to remind everyone of an unpleasant risk of getting caught up in the throes of passion – sexually transmitted diseases (STDs). If you choose to be sexually active, you need a solid understanding of STDs to help you protect your health.

Neisseria gonorrhoeae

I’m going to focus on gonorrhea – or “the clap,” as it is known. There are over 700,000 new gonorrhea cases in the United States each year. The disease is spread from the infected person to their partner by direct contact, usually the penis, vagina, mouth, and/or anus; occasionally transmission occurs from mother to infant during delivery. (I’ll spare you the graphic details on signs and symptoms but invite you to check out the gonorrhea page on CDC’s website.)  Even scarier, in addition to a wide array of unpleasant symptoms, gonorrhea infections increase the risk of HIV transmission and can cause permanent reproductive damage in both men and women.

One particularly worrisome form of the disease is antibiotic-resistant Neisseria gonorrhoeae.  The strains causing this gonorrhea have evolved their genetics to ignore various antibiotics, making the infections difficult to treat and easy to spread.

The original cure for gonorrhea was penicillin, but strains that produce penicillinase were noted as early as 1976. Penicillinase is an enzyme produced by bacteria that rips the drug’s beta lactam ring and deactivates its ability to kill bacteria. In short, the bacteria outsmarted penicillin. Since then, these bacteria have continued to develop resistance to other antibiotics including spectinomycin, tetracyclines, fluoroquinolones, and cephalosporins. Last year, high level resistance to azithromycin (a commonly prescribed drug for the disease) appeared for the first time in the U.S.

Where do many of these strains show up?  Interestingly, here in the Aloha State.  Hawaiiwas the first state to identify penicillinase producing N. gonorrhoeae (1976) and N. gonorrhoeae resistant-strains to spectinomycin (1989), tetracycline (1993), and ciprofloxacin (1993). Convenient travel to and from Asia and other areas where resistance emerges contributes to this pattern in Hawaii.

Here in Hawaii, the Department of Health has active outreach to collect cultures from as many positive patients as possible – succeeding up to 50% of the time statewide.  The State Laboratories Division tests the positive gonorrhea cultures (189 isolates in 2011) for resistance to five different antibiotics. Any isolates with resistance are sent to the Gonococcal Isolate Surveillance Project (GISP) Regional Lab at theUniversity ofWashington inSeattle to be tested further and added to the database. This project monitors resistance trends and helps healthcare providers choose the best treatments for their patients. In 2011, the first case of gonorrhea with high-level resistance to azithromycin in theU.S. was detected by the Hawaii State Lab and confirmed by the GISP Lab.  Great lab science, but not exactly the kind of thing the tourism board wants to hear.

What does this mean for everybody? Look at this trend as another great reason to take care of your sexual health. Until you are in a mutually monogamous, long-term relationship, in which you are sure of your partner’s sexual health, use condoms, monitor symptoms, and get tested for gonorrhea and other STDs if you have exposure risks. Above all, stay safe!

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