Antibiotic resistant gonorrhea on the rise

CARLY WEEKS
Globe and Mail February 3, 2009 at 9:13 AM EST

A strain of antibiotic-resistant gonorrhea is growing in Ontario at an alarming pace, raising fears that the era of practising safe sex is on its way out, according to a new Canadian study.

Rates of gonorrhea resistant to antibiotics known as quinolones jumped from 4 per cent of cases in 2002 to 28 per cent in 2006, a study published today in the Canadian Medical Association Journal reveals.

"The magnitude of the rate of resistance to quinolones is unusually high by any threshold reported in North America," the study said.

The findings add further woe to already-surging gonorrhea infection rates. From 1997 to 2007, infection rates more than doubled in Canada, from 15 to 35 cases for every 100,000 people.

Growing evidence suggests that gonorrhea, a highly adaptable infection, is becoming increasingly resistant to a variety of antibiotics, which has major implications for future control and treatment of the disease.

The rising incidence of quinolone-resistant gonorrhea confirms those worries.

Gonorrhea is a sexually transmitted bacterial infection that, if untreated, can lead to pelvic pain and scarring of the fallopian tubes in women and of the urethra in men, contributing to infertility in both genders.

The increased infection rates raise concerns that people are abandoning safe-sex practices, which could have major and wide-reaching effects on the population's health, according to Susan Richardson, head of microbiology at the Hospital for Sick Children and senior author of the study.

"We are concerned that people are not taking the same precautions for the prevention of sexually transmitted infections that they could," said Dr. Richardson, who is also a consultant to the Ontario Agency for Health Protection and Promotion.

Quinolone-resistant gonorrhea was most commonly found in people over 30, the study found.

While other studies have shown quinolone-resistant gonorrhea to be most prevalent among men who have sex with men, this study found rates were split evenly with heterosexual men.

The resistant strain of gonorrhea could have spread through Ontario's population from people who have visited Asian countries where the disease is widespread, the study said.

Ontario may have higher rates of quinolone-resistant gonorrhea because it is the largest province and a major transit hub.

Other highly populated travel centres, such as Sydney, Australia, also have high rates of the antibiotic-resistant infection, according to an editorial published along with the study.

While the spike in quinolone-resistant cases appears to be greatest in Ontario, experts predict the trend will spread.

"The likelihood is that this will increase [in Ontario] and increase [in] every province too," Dr. Richardson said.

There are other treatments to battle gonorrhea, including a group of antibiotics known as cephalosporins that some countries including Canada now recommend instead of quinolones.

Some people, however, may be allergic to those medications, making their gonorrhea difficult to treat and raises their risk of health consequences, such as infertility.

But an even bigger issue is that some reports show that strains of gonorrhea resistant to cephalosporins are emerging in Pacific Rim countries, according to the editorial written by John Tapsall, who is with the World Health Organization Collaborating Centre for Sexually Transmitted Diseases at the Prince of Wales Hospital in Sydney.

One of the biggest disadvantages of antibiotics is that diseases can mutate and become resistant to the medication, according to Dr. Tapsall.

Public health officials must take action to bring infection rates down to prevent more resistant strains from emerging and further limiting gonorrhea treatment options, he wrote.

"A recognition of these parallels [between quinolones and cephalosporins] has led to renewed calls for better control of gonococcal disease, including enhanced global surveillance of resistance and improved treatment."


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