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Gonorrhea, Then And Now

  • Claire Panosian Dunavan is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and a past-president of the American Society of Tropical Medicine and Hygiene.

  • Last month, an article in Nature about a novel oral treatment for gonorrhea brought good news for anyone who might one day contract the sexually transmitted infection (STI), which was recently estimated to infect roughly 80 million people every year.

    The report on zoliflodacin, which is not yet approved in any country, was also heartening because the drug's phase III testing was "the largest global trial ever conducted for a new treatment against gonorrhea," according to Pierre Daram, PhD, MBA, the STI Treatment Project leader for the Global Antibiotic Research and Development Partnership (GARDP). GARDP is the Geneva-based non-profit that led the trial, and its direct involvement represents an important turning point in the ongoing battle against drug-defying microbes.

    Nonetheless, I found the title and sub-title of the Nature piece, "'Ground-breaking': first treatment targeting 'super-gonorrhoea' passes trial: Antibiotic could turn the tide on drug-resistant form of the infection -- if it's used wisely," both hopeful and sobering. Why?

    At the same time we urgently need new drugs to treat Neisseria gonorrhoeae, we also need better messaging around condoms. After all, although hardly foolproof, they are still quite effective in preventing STIs.

    And yet: condom-less sex is back, especially among men who have sex with men (MSM). My UCLA colleague Pamina Gorbach MHS, DrPH, whose research focuses on bio-behavioral dynamics of sexual health, recently confirmed this: "For women and hetero males, they [condoms] serve the dual purpose of preventing pregnancy and STIs and HIV. But for the MSM community in the U.S., HIV PrEP [pre-exposure prophylaxis with anti-viral pills or injections] has been a real game-changer."

    This leads to an urgent question: In this latest era of sexual liberation, how can we encourage people who risk getting gonorrhea to consider the greater global good of using condoms in order to prevent its possible antibiotic melt-down?

    Gonorrhea's Ups and Downs

    As a former history major, I've always been interested in cycles of infection. Here's what I recently learned from decades of data from the CDC: After peaking in 1975 at 464 infections per 100,000 Americans, gonorrhea's incidence was down to 98 by 2009. Then, 12 years later in 2021, it had more than doubled to 214 cases per 100,000.

    More than 710,000 reported cases in 2021 also show its 28% rise over just 5 years, thus firmly establishing gonorrhea as our country's second most common STI after chlamydia.

    Experts believe that many factors account for gonorrhea's latest rebound, which has disproportionately hit young people ages 15 to 24, gay and bisexual men, and racial and ethnic minority groups. For one thing, STI-associated stigma and socio-economic barriers to care are perennial issues hindering treatment. Casual, one-time hook-ups and the dangerous mix of sex plus recreational drugs are also fueling transmission. Finally, experts wonder, is a lessening fear of HIV prompting less concern about unprotected sex?

    Meanwhile, ever lurking in the shadows, is N. Gonorrhoeae's growing antibiotic resistance.

    The Problem With Modern Diagnostics

    Working as a medical resident in Chicago in the late 1970s, I saw many classic cases of gonorrhea. Men with a gooey, urethral discharge or chronic urinary stricture. Women with red-hot pelvic inflammation or post-infectious scarring leading to an ectopic pregnancy or infertility. Scattered pustules or septic arthritis due to bloodborne spread of the fastidious, Gram-negative diplococci found in aspirated pus or cloudy drops of synovial fluid that a microbiology tech would then try to grow on a chocolate agar plate.

    Today's trainees may not have seen those culture plates, but they are still seeing plenty of patients whose genital, rectal, and throat swabs are PCR-positive for N. Gonorrhoeae.

    The good news? With the advent of PCR testing, the organism became easier to detect. The bad news? Using PCR tests, especially in patients on HIV PrEP who are tested for gonorrhea every 3 months, it is now hard to distinguish an active infection from one that's gone. Nor do PCR tests inform us about antibiotic susceptibility.

    Both of these issues can lead to antibiotic overuse, which further jeopardizes today's remaining regimen for uncomplicated gonorrhea.

    Waning Antimicrobial Weapons

    This leads us back to the historical context. Ever since the 1930s and 1940s, when sulfa drugs were only briefly effective against N. Gonorrhoeae, the organism has displayed ongoing antibiotic resistance. For the next several decades, its eradication required ever-higher doses of penicillin. Then drugs in the fluoroquinolone (FQ) class replaced penicillins and tetracyclines, until FQ-resistant strains emerged in Asia and the Pacific Basin and later spread worldwide.

    By 2007, FQs were dropped from all CDC regimens and third-generation cephalosporins like ceftriaxone combined with azithromycin later became WHO's treatment of choice for genital and anorectal infections.

    But that was then. Now extremely drug-resistant (XDR) strains are signaling a slowly unfolding global crisis.

    Scoping the Future

    Like Gorbach, my UCLA colleague Paul Adamson, MD, MPH, is another STI researcher as well as a clinician who is currently focused on gonorrhea in global settings. In another few weeks, he'll start a 3-month stint at the Sexual Health and Promotion Clinic at Hanoi Medical Center, Vietnam's first facility to offer HIV PrEP. While there, the infectious diseases doctor will not only characterize local strains of N. Gonorrhoeae but will begin to correlate clinical presentations and patient behaviors with antibiotic resistance.

    Adamson was enthusiastic when he heard the news of zoliflodacin; at the same time, he felt a need to protect it. "It seems like it's as effective as ceftriaxone and azithromycin, so that's exciting," he said, "but you also want to hold it for cases in which you can't use ceftriaxone. I fear that will be really hard to do."

    His concern stemmed from the fact that relatively few isolates of N. Gonorrhoeae are cultured these days -- yet a culture is still the only way to identify ceftriaxone-resistant strains in individual patients.

    Daram sees things differently. As he told me over email, GARDP's aim "is to limit the clinical use [of zoliflodacin]...To the targeted disease only." He's hoping this tactic will largely rein in future resistance to the novel agent.

    "Wouldn't that be great?" I thought while reading his message. Yet, all the while, I kept thinking about condoms.

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    'Super Gonorrhea' Is Spreading Like Wildfire Thanks To COVID-19

  • Overuse of antibiotics during the coronavirus pandemic has resulted in the more rapid spread of a type of antibiotic-resistant gonorrhea.
  • This so-called 'Super Gonorrhea' does not respond to the normal first-line treatments, making it particularly dangerous and uncomfortable for those afflicted.
  • Doctors and medical experts have long warned of the possibility that "superbugs" that are antibiotic-resistant could become more commonplace, and this is one example of such a thing happening.
  • 2020 hasn't been kind to anyone, but it's almost over. Unfortunately, if you find yourself with a case of "Super Gonnorhea" you might feel the effects of this terrible year for an extended period of time. Doctors are now warning of the increasing spread of the antibiotic-resistant strain of STI, and they're blaming the coronavirus pandemic for helping it gain momentum.

    According to a report from The Sun, the problem has gotten so bad that the World Health Organization has taken notice. The issue is that as the coronavirus pandemic was ongoing, many clinics and hospitals used antibiotics in the treatment of patients and to prevent the cross-infection of hospitalized individuals. That overuse of antibiotics has given a boost to antibiotic-resistant gonorrhea, according to WHO.

    Antibiotics are great. They have saved countless lives and provided mankind with the incredible power to rid ourselves of problematic microbes. Unfortunately, as the decades began to pile up, the very microorganisms we fought using antibiotics began to find ways around them. Now, several types of antibiotic-resistant bacteria are known to exist, and these "superbugs" require more complex treatment that sometimes includes multiple antibiotics or newer versions of drugs that are not yet compromised.

    In the case of gonorrhea, the bacterium that causes the infection has, over time, adapted to common first-line treatments. In particular, the new "super" strain of the infection doesn't respond to treatment with azithromycin, which has long been the go-to medication option.

    "Overuse of antibiotics in the community can fuel the emergence of antimicrobial resistance in gonorrhoea," a WHO spokesperson told The Sun. "Azithromycin – a common antibiotic for treating respiratory infections – was used for Covid-19 treatment earlier in the epidemic."

    "During the pandemic, STI services have also been disrupted. This means more STI cases are not diagnosed properly with more people self-medicating as a result. Such a situation can fuel emergence of resistance in gonorrhea including gonorrhea superbug (super gonorrhoea) or gonorrhoea with high level resistance to current antibiotics recommended to treat it."

    The worst part is that the number of people reporting a new gonorrhea infection is growing year-over-year, to the tune of about 17%. That means more and more people are getting the infection, and the antibiotic-resistant strain of the bacteria has an even larger population of people to further its adaptation to medications and other treatments.

    Be safe out there.

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    Drugs For Treatment Of Conjunctivitis

    Are you searching for medications to treat 'Conjunctivitis'? Welcome to this section, which serves as a repository for medications that are relevant to the treatment of Conjunctivitis. The page includes both the generic and brand names and can be an invaluable resource for healthcare professionals and individuals who wish to get an insight on different medication options. Click on a medication below to view details including brand names, prices, dosages, side effects, and administration guidelines. Additionally, a FAQs section is available for each medication, addressing popular inquiries and providing deeper insights into its use for Conjunctivitis management. We recommend consulting your doctor to verify the information presented on this page or for any additional clarifications. Advertisement Brand Names and Generic Names of Drugs for Treatment of Conjunctivitis Alcaftadine Ophthalmic Solution Alcaftadine ophthalmic solution is an antiallergic agent prescribed to treat or prevent itching due to eye irritation or pink eye associated with allergic conjunctivitis. Atropine Ophthalmic Atropine Ophthalmic is an anticholinergic agent, prescribed for inflammatory eye disorders. Advertisement Atropine Sulfate Ophthalmic Atropine Sulfate Ophthalmic is a tropane alkaloid, prescribed for dilatation of pupil. Besifloxacin Ophthalmic Suspension Besifloxacin Ophthalmic Suspension is a quinolone antibiotic, prescribed for bacterial conjunctivitis. Betamethasone Ophthalmic Betamethasone Ophthalmic is a corticosteroid, prescribed for eye inflammation. Advertisement Carbenicillin Carbenicillin is a penicillin antibiotic, prescribed for certain bacterial infections. Trade Names : Cefditoren Cefditoren is a third-generation cephalosporin antibiotic, prescribed for certain bacterial infections. Trade Names : Cefetamet Cefetamet is a cephalosporin antibiotic, prescribed for susceptible infections. Trade Names : More... Erythromycin Ethylsuccinate Granules Erythromycin Ethylsuccinate Granules is a macrolide antibiotic, prescribed for bacterial infections. Ganciclovir Ganciclovir is an antiviral agent, prescribed for cytomegalovirus (CMV) retinitis (eye infection that can cause blindness) in people who have received organ or bone marrow transplants. Trade Names : Gatifloxacin Gatifloxacin is an antibiotic, prescribed for certain types of bacterial infections such as conjunctivitis, sinusitis, skin and skin structure infections, cystitis. Trade Names : More... Gentamicin Gentamicin is an antibiotic, prescribed for severe bacterial infections. Trade Names : More... Gentamicin Ophthalmic Gentamicin Ophthalmic is an antibiotic, used to treat bacterial infections of the eyes. Trade Names : More... Homatropine Homatropine is an anticholinergic agent, prescribed for dry cough along with hydrocodone. Trade Names : More... Hydrocortisone, Neomycin and Polymyxin Hydrocortisone, Neomycin and Polymyxin contains two antibiotics and a corticosteroid, prescribed for ear, eye and skin infections. Idoxuridine Ophthalmic Idoxuridine Ophthalmic is an antiviral agent, prescribed for certain eye infections. Trade Names : Ketorolac Ketorolac is a non-steroidal anti-inflammatory agent (NSAID), prescribed for short-term management of severe pain, usually after surgery that requires analgesia (pain killer) at the opioid level and free from opioid side effects. Trade Names : More... Ketorolac Trometamol Ophthalmic Ketorolac Trometamol Ophthalmic is a non-steroidal anti-inflammatory agent (NSAID), prescribed for post operative eye inflammation and pain. Ketotifen Ketotifen is an antihistamine, prescribed for asthma, allergic conjunctivitis and other allergic conditions. Trade Names : More... Levocabastine Levocabastine is an antihistamine, prescribed for seasonal allergic conjunctivitis. Lodoxamide Tromethamine Lodoxamide Tromethamine is a mast cell stabilizer, prescribed for the treatment of redness, burning, itching, and swelling of the eyes. Loteprednol Loteprednol is a corticosteroid, prescribed for eye swelling caused by surgery, infection, allergies, and other conditions. Trade Names : Medrysone Liquifilm Ophthalmic Medrysone Liquifilm Ophthalmic belongs to a class of drugs called corticosteroids, prescribed for allergic conjunctivitis. Naphazoline Naphazoline is a decongestant, prescribed for conjunctivitis with symptoms of redness (mainly due to vasodilation of the peripheral small blood vessels), swelling of the conjunctiva, itching and increased production of tears, relieving stuffy nose due to cold, hay fever, or other upper respiratory allergies associated with sinus inflammation. Trade Names : More... Naphazoline/ Pheniramine - Ophthalmic Naphazoline/ Pheniramine - Ophthalmic is a decongestant and antihistamine combination, prescribed for eye redness, puffiness, itching and watery eyes that commonly occur with allergies. Natamycin Natamycin is an antifungal antibiotic, prescribed for eye and skin infections. Trade Names : More... Norfloxacin Norfloxacin is a synthetic chemotherapeutic agent, prescribed for urinary tract infections and eye infections. Trade Names : More... Olopatadine Olopatadine is an antihistamine, prescribed for symptoms of allergic pink eye (Allergic conjunctivitis). Trade Names : More... Oxacillin Injection Oxacillin Injection is a penicillin antibiotic, prescribed for certain bacterial infection. Pemirolast Ophthalmic Pemirolast Ophthalmic is a mast cell stabilizer, prescribed for itching of the eyes due to allergic conjunctivitis. Polymyxin, Bacitracin and Neomycin Polymyxin, Bacitracin and Neomycin is an antibiotic, prescribed for eye and other bacterial infections. Prednisolone Ophthalmic Prednisolone Ophthalmic is a corticosteroid, prescribed for eye inflammation. Rimexolone Ophthalmic Rimexolone Ophthalmic is a corticosteroid, prescribed for swelling, itching, redness, and irritation of the eyes and eyelids. Sisomicin Sisomicin is an aminoglycoside antibiotic, prescribed for conjunctivitis, keratitis, blepharitis and other bacterial infections. Trade Names : Sulfacetamide and Prednisolone Sulfacetamide and Prednisolone is an antibacterial and corticosteroid combination, prescribed for eye inflammation. Sulfacetamide Ophthalmic Sulfacetamide Ophthalmic is a sulfonamide with antibacterial activity, prescribed for eye infections. Suprofen Suprofen is a nonsteroidal anti-inflammatory drug, prescribed for reducing pain and inflammation in the eyes. Tobramycin Ophthalmic Tobramycin Ophthalmic is an antibiotic, prescribed for bacterial eye infections. Trade Names : More... Search for Drugs: For Related Medical Condition Suggested Readings on Conjunctivitis Interactive section of Medindia gives general information about Laser Eye Surgery Long sightedness also known as hyperopia or farsightedness is a common vision problem. Long-sighted people have difficulty seeing near objects than distant objects. Myopia is the inability of a person to see the distant objects clearly. Myopia is also known as near or short sightedness. A list of eye tests to find out how healthy your eyes are. Contains a brief about visual accuracy test, distance acuity test and macular function test. Check for visual impairment and degeneration in any part of your eyes. Retinoblastoma is a type of cancer of the eye occurring in children. Early diagnosis and treatment, and genetic counselling can go a long way in saving life and vision in children and siblings at risk for this disease. Eye pain usually follows trauma, eye infection or inflammation of the eye and the surrounding structures. The cause of eye pain can be diagnosed based on the type of pain and associated symptoms. Pink eye, is the redness in the eye, which is caused due to inflammation of the conjunctiva. Conjunctiva is the lining that covers the eyelid and eye surface. Do your eyes water? Are you experiencing excessive tear production? Prevent persistent tearing as these signs may not be just due to conjunctivitis. Neonatal conjunctivitis occurs in newborn babies during the first month of birth. It can be caused by bacteria, virus or under aseptic conditions.




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