Reports of a new “sex superbug” threatening the U.S. aren’t true, public health officials say, even as they reiterate worries about the rise of drug-resistant gonorrhea.

“The sky is not falling -- yet,” said Dr. Kimberly Workowski, a professor of infectious disease at Emory University in Atlanta.

Several media outlets, including The Associated Press, last week reported that a rare strain of gonorrhea known as HO41 had been detected in Hawaii. That would have raised alarms nationwide, signaling the first domestic sign of a strain that's been found to be resistant to ceftriaxone, an injectable antibiotic that is the last-resort treatment for the sexually transmitted infection.

But the Hawaii cases, first discovered in May 2011, were actually a different strain, H11S8, resistant to a different drug, the antibiotic azithromycin, state health officials confirmed. That’s been a known problem for a while, Workowski added. The AP later withdrew the inaccurate report.

In fact, the HO41 strain hasn’t been detected anywhere in the world since 2009, when it was found in a Japanese sex worker, said Dr. Robert Kirkcaldy, a medical epidemiologist with the Centers for Disease Control and Prevention.  A handful of other cases that are resistant to ceftriaxone have been detected in other countries, but they’re different isolates, he added.

The false reports have put public health experts in the unusual position of refuting an error while also emphasizing that the threat of untreatable gonorrhea in the U.S. is very real.

“We think that that could be just a matter of a year or two,” said William Smith, executive director of the National Coalition of STD Directors.

Nearly 322,000 cases of gonorrhea were reported in the U.S. in 2011, making it again the second most commonly reported notifiable infection in the nation. Sufferers often show no signs, so the actual number of infections is likely closer to 700,000, according to the CDC.

For decades, gonorrhea was easy to treat with a single dose of antibiotics. But the germ is wily and easily mutable. It developed resistance to successive classes of drugs over the years until the cephalosporins, the current treatment, were all that’s left.

In recent years, though, there have been worrisome signs that the bug is starting to outsmart those drugs, too. Last year, the CDC stopped recommending the oral antibiotic cefixime to treat gonorrhea after surveillance showed it was on the verge of resistance. Now, the recommended treatment is the injectable ceftriaxone along with two other antibiotics, azithromycin or doxycycline.

“The point was to actually preserve the last remaining drug we know is effective,” said Workowski.

The NCSD, led by Smith, has asked Congress for $54 million in emergency appropriations to help bolster the US public health infrastructure that monitors, diagnoses and treats gonorrhea.

“Untreated gonorrhea is a disaster for public health and HIV prevention,” Smith said.

The best prevention against gonorrhea is monogamous sex between uninfected partners, Kirkcaldy said. Diligent use of condoms can also prevent infection, he added.

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By Julie Steenhuysen
Reuters

The only remaining oral antibiotic used for gonorrhea failed to cure the infection in nearly 7 percent of patients treated at a clinic in Toronto, Canadian researchers said on Monday in the first published study of treatment-resistant gonorrhea in North America. 

The study raised alarm among U.S. health officials, who have ordered doctors to stop prescribing the antibiotic known as cefixime because lab cultures showed gonorrhea was starting to develop resistance to the drug.

That left U.S. doctors with only one effective treatment for most cases of gonorrhea, an injectible antibiotic known as ceftriaxone.

"We've been very concerned about the threat of potentially untreatable gonorrhea in the United States," Dr. Gail Bolan, director of the Centers for Disease Control and Prevention's division for sexually transmitted diseases, said in a telephone interview

There have been a number of cases in Europe, but "this is the first time we've had such a report in the actual North American continent," she said. "We feel it's only a matter of time until resistance will occur in the United States."

Until now, signs of antibiotic resistance in North America have been detected mostly through lab tests, which have shown a steady increase in the amount of antibiotic cefixime - marketed by Lupin Ltd as Suprax - that was needed to kill gonorrhea.

"We had seen one case beforehand, but this is the first published report, and it's also the first series of cases in North America," said Dr. Vanessa Allen of Public Health Ontario in Canada, who led the study published in the Journal of the American Medical Association.

Allen and colleagues studied nearly 300 individuals with gonorrhea between May 2010 and April 2011 who were treated with cefixime at a clinic in Toronto, looking for any patients who were still infected during a follow-up visit.

Of the initial 300, 133 returned for retesting. Of those, 13 were still infected, but only nine said they had not had sexual contact that might have reinfected them. That left a failure rate of 6.7 percent.

Allen said the study is a preliminary finding, but still important because it offers some confirmation that people treated with cefixime are not being cured.

It also points out a weakness of newer DNA-based tests commonly used to test for gonorrhea.

Previously, doctors would take fluid samples from patients and grow cultures of gonorrhea bacteria in lab dishes, which could then be used to identify drug resistance. More advanced DNA-based tests, such as nucleic acid amplification tests, cannot be used to test for antibiotic resistance.

"I do think reinvesting in culture-based methodologies is warranted," Allen said, adding that doctors should consider sending patients for retesting to make sure they have been properly treated.

If left untreated, gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies and infertility in both men and women.

In the United States, there are approximately 300,000 reported cases of gonorrhea each year. But because infected people often have no symptoms, the actual number of cases is likely closer to 600,000, Bolan said.

So-called "superbug" drug-resistant strains of gonorrhea accounted for almost one in 10 cases of sexually transmitted disease in Europe in 2010, more than double the rate of the year before, health officials from the Stockholm-based European Centre for Disease Prevention and Control said in June.

In addition to closely monitoring for resistance, Bolan said the CDC it is working with its partners at the National Institutes of Health and pharmaceutical companies to encourage the development of new antibiotics and test new combinations of existing drugs. 

Would-be lovers wondering whether to go forward with a new relationship might heed the advice of Russian scientists: Take a deep whiff.

Sniffing a potential partner’s scent could tell whether Mr. Right has a sexually transmitted disease, according to a small study that found that gonorrhea-infected men smelled “putrid” to a bevy of young ladies.

“Our research revealed that infection disease reduces odor attractiveness in humans …” wrote Mikhail Moshkin, a professor at the Institute of Cytology and Genetics in Novosibirsk, Russia, and the lead author of research published in the most recent issue of the Journal of Sexual Medicine.

The off-putting scent may be subtle, more a chemical warning than a blast of body odor, but it definitely has an effect, according to the experiment conducted by Moshkin and his colleagues.

The researchers had long observed that certain animals, such as mice and rats, were not as attracted to the scents of other critters when they were infected with disease. They wondered whether humans, too, would be turned off by the scent of an infected person, particularly one harboring an STD.

So they invited 34 strapping Russian guys, ages 17 to 25, to donate samples of armpit sweat and spit for the cause of science. The group included 13 young men with gonorrhea, 16 who were healthy and five who had had the disease but were successfully treated.

Then they found 18 female students aged 17 to 20 from Kemerovo State University in Russia who were willing to serve as sweat-sniffers.

They obtained sweat samples by dressing the men in tight-fitting T-shirts with cotton pads sewn into the armpits. After an hour of sweating, men bagged their shirts and the pads were placed in glass vials for the women to sniff.

The results couldn’t have been more obvious. The women ranked the infected men less than half as high as healthy or recovered guys on a “pleasantness score” that assessed scent.

And when they were asked to characterize the scent, the gals said that nearly 50 percent of the infected men’s sweat smelled “putrid." (To be fair, the gals also said that 30 percent of sweat from healthy men and less than 40 percent of sweat from treated men smelled putrid, but these are guys -- and it was significantly higher for the gonorrhea group.)

The take-away message, the researchers found, was that it appears that humans, like other animals, might use scent to sniff out appropriate mates.

“We can conclude that unpleasant body odor of infected persons can reduce the probability of a dangerous partnership,” the scientists say.

Heeding olfactory cures might not signal the right partner, but they could warn against the wrong one – unless, of course, the guy uses deodorant.

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