Washington Blade - May 7, 2004
Christopher Seely

"The data presented today show that drug resistant gonorrhea is a rapidly emerging health concern, particularly for gay and bisexual men," Dr. John Douglas, the CDC's STD prevention director, said in a conference call with reporters on April 29.

Gay and bisexual men reported incidences of the drug-resistant gonorrhea, Neisseria-gonorrhoeae, at rates 12 times higher than straight men, based on CDC data acquired in clinics from 30 U.S. cities between 2002 and 2003.

Reports show gay and bisexual men are resistant to flouroquinolones, a category of antibiotics used to treat urinary tract infections and gonorrhea, among other bacterial ailments.

Resistance among straight men also increased, but at a slower pace, Douglas said.

Between 2002 and 2003, the percentage of drug-resistant gonorrhea cases among straight men increased from 0.2 percent to 0.4 percent.

But among gay and bisexual men, the number of drug-resistant cases increased from 1.8 percent in 2002 to 4.9 percent in 2003, according to the CDC data.

Undiagnosed and untreated gonorrhea also facilitates HIV infection, Douglas said.

"There is mounting evidence these increasing STD rates are fueled by a variety of factors," he said, including relaxed safer sex practices, substance abuse, crystal methamphetamine use and the availability of the Internet for meeting sex partners.

To treat the bacterial disease in gay and bisexual men, the CDC recommended that doctors switch from the usual prescription of the drug Cipro in pill form, to one of two injectable drugs.

The decision as to which injectable drug, ceftriaxone or spectinomycin, depends on if a person is infected in the mouth, anus or penis, Douglas said.

Federal health officials recommended women and heterosexual men should continue to receive oral Cipro treatments, except in California and Hawaii, Douglas said.

In 2002, the CDC recommended doctors in California prescribe the injectable treatments instead of Cipro for all gonorrhea infections, straight or gay, because of increasing resistance to flouroquinolones.

Staying in gay circles

The same recommendation was made to Hawaiian doctors in 2000, and federal health officials speculate that the drug-resistant strains migrated eastward by gay travelers, according to Douglas.

Gonorrhea is transmitted sexually, meaning that if a gay man is infected with a drug-resistant strain, it is more likely to remain within gay circles and cause the strain to be amplified there, said Dr. Kenneth Mayer, medical research director at Fenway Community Health, a gay health center in Boston.

"It is more likely than not that the majority of partners they have are going to be other gay men," Mayer said.

Sexually anal-receptive gay men could also harbor gonorrhea in their anuses and carry it unknowingly for long periods of time since anal gonorrhea is often less symptomatic, Mayer said.

Symptoms of gonorrhea usually appear within two to 10 days of exposure, and for men include pus discharge from the penis and possible burning sensations during urination.

Rectal infection symptoms include itching, discharge and occasional painful bowel movements with bleeding.

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