Gonorrhea infections up in first half of 2010

The Philadelphia Department of Public Health issued an advisory to doctors and other providers in the city that it received 2,876 reported cases of gonorrhea in the first six months of 2010, up 26 percent compared with the same period last year.

Gonorrhea is the least-serious of major sexually transmitted diseases, and it is possible that the higher numbers reflect more testing. Still, after several years of modest declines, to 4,823 in 2009, the jump in the first half of this year is a public health concern, said Caroline C. Johnson, the director of the health department’s Division of Disease Control.

Gonorrhea can be spread through oral, anal and vaginal sex. The infection is caused by the bacteria Neisseria gonorrhoeae.

Johnson said that, beyond the increase in reported cases of gonorrhea, she was also concerned that some doctors might be unaware that 10 to 30 percent of the infections are resistant to the antibiotic ciprofloxacin – cipro – and that “treatment failures” related to use of that drug could be contributing to the increase.

The advisory issued Monday recommends that doctors use alternative antibiotics – ceftriaxon or cefixime.

In men the symptoms of genital gonorrhea are pain during urination (dysuria) and puss-like discharge from the urethra. Women typically experience vaginal discharge and discomfort if they have symptoms -- most genital gonorrhea infections in women are asymptomatic.

Thomas Fekete, chief of the division of infectious diseases at the Temple University School of Medicine, said that the estimated 10 percent of men and significantly larger number of women who don’t know they have the infection, and therefore do not seek treatment, can contribute to its spread.

Those at highest risk for contracting gonorrhea and other STDs include:

  • People who are under 25 years of age
  • Those with a history of previous STDs
  • Individuals with multiple sexual partners
  • Those who don’t use condoms consistently
  • People engaged in sex work or drug users.

The city’s health advisory said that patients being treated for gonorrhea should be simultaneously treated for Chlamydia infections unless they have tested negative for it.

Fekete said it was discouraging that people who had already contracted an STD are at such high risk for getting another since “you would hope they would know that condoms were protective if used correctly.”

Gonorrhea is relatively benign in most cases, although some women develop a more serious infection (pelvic inflammatory disease) and the bacteria can be transmitted to babies during childbirth. A gonorrhea infection suggests that someone is engaged in activities that put them at higher risk of more serious STDs, including HIV, Fekete said.

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