Infectious Diseases

Hawaii’s Unique Public Health Challenges: Antibiotic Resistant Gonorrhea

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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