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UK man contracts drug-resistant super-gonorrhoea

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    Posted: April 07 2018 at 3:19pm

UK man contracts drug-resistant super-gonorrhoea

By Amalie Finlayson

Updated 29 Mar 2018, 3:45pm

What has been dubbed the world's "worst-ever" case of super-gonorrhoea has been found in a man who attended an English sexual health clinic early this year, according to a report published by Public Health England.

Health Officials say it is the first time this strain, neisseria gonorrhoeae, cannot be cured with the regular treatment.

The unidentified heterosexual man had one regular female sexual partner in the UK, and reportedly had sexual contact with a woman in south-east Asia one month before his symptoms began.

Gonorrhoea is usually treated with a combination of antibiotics azithromycin and ceftriaxone, but in this case the treatment has not been successful.

Australian GPs on the lookout

Sexual health specialist Nicholas Medland, from the Australian Society of HIV, Hepatitis and Sexual Health Medicine, said the new "super" strain was concerning.

"Those two antibiotics are also the first line of treatment in Australia for cases of gonorrhoea," he said.

"Multi-drug resistant infections, and in the past drug-resistant gonorrhoea, have first appeared in Australians returning from Asia.

"In Asia there is much less well-controlled antibiotic use — that is why the resistance develops."

Dr Medland said while Australia had a good track record of identifying and responding early to drug-resistant gonorrhoea, future defence against such super strains relied on doctors following appropriate testing and treatment guidelines.

"The main risk would be if a person visited a doctor inexperienced in treating sexually transmitted diseases and it could be missed," he said.

However Dr Medland said that due to a general increase recently in gonorrhoea cases in Australia, state health departments were raising awareness with general practitioners and encouraging appropriate testing and treatment for the disease.

"The key is to identify it early and prevent it from spreading, while the case is appropriately managed," he said.

"Clearly Australians should also practice safer sex while travelling, and if people see themselves at risk they should get tested as soon as they get back to Australia — and avoid any sex at all until then.

"If people think they might be at risk, people should also be be very upfront about what they did, with whom and where."

Officials trying different drugs on infected man

Health officials in the UK say they are treating the infected man with different drugs to see whether they are effective in treating this virulent strain of the bug.

They will know whether treatment has been successful in the next month.

Meanwhile, an incident management team has been created to coordinate the investigation and contain the potential spread of the disease.

Tests on the man's female partner have proved negative. No further cases have yet been identified, but health services are also following up on any other sexual contacts the man may have had.

Gwenda Hughes from Public Health England told the BBC it was an unprecedented case.

"This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics," Dr Hughes said.

Health services in the UK have recommended GPs refer all suspected cases of gonorrhoea to national health services so they can be managed appropriately.

They are recommending that anyone who contracts the disease be carefully monitored to ensure prompt diagnosis, effective treatment, partner notification and a full screen for sexually transmitted diseases.

12 Monkeys...............
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 07 2018 at 3:38pm

How did gonorrhea become a drug-resistant superbug?

April 4, 2018 by Mark Derewicz, University of North Carolina Health Care
Neisseria gonorrhoeae. Emanating from the cell bodies are Pili -- protein polymers involved in movement, adhesion, and DNA transformation. Credit: Nicholas Lab, UNC School of Medicine

The bacterium that causes the sexually transmitted disease gonorrhea is resistant to multiple standard antibiotics and now threatens to develop resistance against ceftriaxone, which is on the World Health Organization List of Essential Medicines and is the last effective antibiotic against the organism. UNC School of Medicine researchers have identified mutations to the bacterium Neisseria gonnorrhoeae that enable resistance to ceftriaxone that could lead to the global spread of ceftriaxone-resistant "superbug" strains.

The findings, published in the journal mBio, provide unique insights into the evolution of drug-resistant gonorrhea that should be useful in monitoring the disease and perhaps in defending against it.

"The first step in stopping a drug-resistant bacterium is figuring out how it becomes resistant to antibiotics that once were able to kill it," said study co-senior author Robert Nicholas, PhD, professor and vice chair of UNC's Department of Pharmacology. "Our results give us clues to how ceftriaxone-resistant gonorrhea is emerging, why this is such a looming problem, and what to focus on to limit it."

Gonorrhea has been a public health problem for hundreds if not thousands of years. In the United States, the number of cases per capita per year rose sharply in the 1960s, then fell just as sharply when the HIV pandemic began. For the past few years the rates of gonorrhea have been rising steeply again. There are more than 800,000 cases per year in the U.S., and worldwide cases are estimated at 80 million annually. About 20,000 people in North Carolina have gonorrhea, according the Centers for Disease Control and Prevention, and the state has the fifth highest rate of infection in the country - about 200 individuals out of 100,000.

If untreatable, complications include infertility, prostate inflammation, scarred and narrowed urethra, testicular and scrotal pain, miscarriage, pelvic inflammatory disease, and inflammation of the bladder.

There is no vaccine for gonorrhea, so antibiotic therapy is the only option for treating infections. However, N. gonorrhoeae has shown a seemingly limitless capacity for evolving resistance to antibiotics. Doctors since the 1980s have had to abandon one first-line therapy after another - penicillin, then tetracycline, then ciprofloxacin, and most recently cefixime. The current standard therapy is a combination of two drugs - the injectable ceftriaxone and oral azithromycin.

N. gonorrhoeae isn't yet widely resistant to ceftriaxone, but two isolates - H041 and F89 - have been shown to be fully resistant to the drug. These cases have raised concerns that ceftriaxone-resistant gonorrhea might soon spread globally, which would make gonorrhea much more difficult to treat and possibly untreatable.

In the study, Nicholas and colleagues, collaborating with the laboratory of Ann E. Jerse, PhD, at the Pentagon's Uniformed Services University in Maryland, showed first that the ceftriaxone-resisting mutations in HO41 and F89 come with a "fitness cost" for the bacterium. In other words, the mutations dramatically impair the bacteria's growth rate.

That was expected. The ceftriaxone-resistance mutations alter the bacterial enzyme that is the target of ceftriaxone, making it harder for the drug to bind to the enzyme but at the same time making it less able for the enzyme to build and repair bacterial cell walls. This fitness cost would be expected to prevent resistant strains from spreading much. The scientists then conducted lab experiments to show that resistant-mutation strains were vastly outcompeted by a standard, non-resistant strain of N. gonorrhoeae, so that the amount of resistant bacteria dwindled rapidly in comparison to the standard strain.

But then the scientists infected mice with an equal mixture of the non-resistant reference strain and the ceftriaxone-resistant, growth-impaired strain. Here's the bad news: Nicholas and colleagues found that some resistant strains quickly developed much higher growth rates and even began to out-compete the fast-growing reference strain.

"That made us suspect that these bacteria had acquired 'compensatory' mutations that improved their growth rate despite the growth-slowing effect of the resistance mutations," Nicholas said.

Scientists will have to sift through the genomes of these lab-evolved superbug strains to identify all the mutations that restore growth and how they do it. This will be the work of multiple studies to come.

But in an initial set of experiments, Nicholas and colleagues zeroed in on one of these mutations that affects a bacterial enzyme called AcnB, known to play an important role in the bacterial energy-production that fuels bacterial growth. The scientists found that the mutant form of the enzyme not only alters N. gonorrhoeae's energy metabolism but also causes extensive changes in the expression of bacterial genes, effectively switching many off and many others on.

"AcnB may have yet-undiscovered functions - beyond its role in energy metabolism - that explain the fitness advantage the enzyme confers when mutated," Nicholas said.

He and his colleagues are working to understand better how mutant AcnB boosts growth of N. gonorrhoeae and what other growth-restoring mutations exist in the lab-evolved superbug strains. At the same time, the researchers are on the lookout for reports of similar dangerous mutations in strains recovered from patients around the world.

 Explore further: Gonorrhea in China shows waning susceptibility to WHO-recommended antibiotics

More information: Leah R. Vincent et al. In Vivo-Selected Compensatory Mutations Restore the Fitness Cost of Mosaic penA Alleles That Confer Ceftriaxone Resistance in Neisseria gonorrhoeae, mBio (2018). DOI: 10.1128/mBio.01905-17 

12 Monkeys...............
1995 ‧ Science fiction film/Thriller ‧ 2h 11m a must for AFT
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Post Options Post Options   Thanks (0) Thanks(0)   Quote FluMom Quote  Post ReplyReply Direct Link To This Post Posted: April 07 2018 at 7:37pm
In my day 55 years ago we were afraid of getting pregnant. Now no one is worried about that. But Super Drug Resistant STD's even frightens my 20 something son. He has heard about this super bug and I just said see mom is right use a condom!!!

People have to be aware that if you are having sex with someone you had better use protection because they have had sex with many. Some of that "many" may have passed a bad bug to them and now you.

Abstinence may come back into our social moral compass again!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: April 07 2018 at 10:58pm
Carbon, take care on your next trip to Thailand TongueLOL

Well, you are living much closer than I to South-East Asia!  I would like to make one last trip to Thailand and Singapore (to go down memory lane - although the places have developed so much that I probably won't recognise anything! - especially in the build up in Singapore)  but don't see how that trip will ever come about.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote carbon20 Quote  Post ReplyReply Direct Link To This Post Posted: April 08 2018 at 3:21pm
my overseas trips are usually back to the UK to see my Mom,

my next trip is to New Zealand,

just came back from Tasmania,awesome place,

never been to Thailand,

not  on my bucket list ,

back to Sri Lanka(another Awesome place ) next year,

before the tourist stuff the place up LOL,

never been to the states either,

would like to go the yellowstone ,and Yosemite national parks,

anyway ,its probably best to all ways take a "Rain coat"no matter where you are...........


12 Monkeys...............
1995 ‧ Science fiction film/Thriller ‧ 2h 11m a must for AFT
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