Blog | Friday, March 8, 2013

The pathogens of Cupid's arrow

"Love is a burning thing
And it makes a fiery ring"
--Johny Cash

While some think of chocolate, or wine or flowers, physicians think of sexually transmitted infections (STIs). With perfect timing, the Centers for Disease Control and Prevention (CDC) released last month (in time for Valentine's Day) two studies quantifying the burden of STIs in the U.S.

The studies estimated the nationwide burden of eight STIs--chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus (HPV), hepatitis B, HIV and trichomoniasis. The results showed that there are about 20 million new cases of these STIs annually, and that the prevalence of STIs, that is the number of new and existing infections at a given time, is 110 million. Over half of the STIs, both in terms of new infections and prevalent infections, are due to HPV, the virus that can cause genital warts and cervical cancer. And most of the infections are in young people between the ages of 15 and 25. How romantic!

As if that wasn't enough to throw a wet blanket on the national mood, a recent Morbidity and Mortality Weekly Report followed up on a story I first wrote about a year ago, the emerging threat of multi-drug resistant gonorrhea. Gonorrhea remains a serious public health threat in the U.S. with over 300,000 new cases reported in 2011. Peruse my post from a year ago for the detailed history of the gonorrhea bacterium repeatedly overcoming whichever antibiotic we use against it. Since the 1940s, gonorrhea has developed resistance to sulfanilamide, penicillins, tetracyclines, and most recently fluoroquinolones. That leaves cephalosporins as the last family of antibiotics uniformly effective against gonorrhea.

This week's report warns that strains of gonorrhea resistant to cephalosporins have been isolated in Japan, France and Spain in the last few years. Strains in the U.S. remain sensitive to cephalosporins, but laboratory measures of cephalosporin sensitivity in isolated strains are slowly decreasing. No other effective antibiotic alternative is on the horizon, so the appearance of cephalosporin-resistant gonorrhea may essentially mean the appearance of untreatable gonorrhea. How romantic!

So as we approach the end of the antibiotic century, perhaps we should all try to rediscover the virtues of monogamy. That may sound quaintly retrogressive, but no more so than the notion of having no treatments for common infections.

"You must remember this
A kiss is still a kiss
A sigh is just a sigh
The fundamental things apply
As time goes by"
--Herman Hupfeld

Learn more:
'Ongoing, severe epidemic' of STDs in US, report finds (Vitals, NBC News)
CDC Warns of Super-Gonorrhea (ABC News)
'Severe epidemic' of sexually-transmitted diseases is sweeping the nation, warns CDC on Valentine's Day (Daily Mail)
CDC Grand Rounds: The Growing Threat of Multidrug-Resistant Gonorrhea (Morbidity and Mortality Weekly Report)
Incidence, Prevalence, and Cost of Sexually Transmitted Infectious in the United States (CDC Fact Sheet)
My last post about multi-drug resistant gonorrhea: Untreatable Gonorrhea – The Next Infectious Threat

Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.