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Gonorrhea: The emerging superbug

REUTERS/Lucas Jackson
Minnesota ranks 34 among 50 states in gonorrhea infections with a total of 4,097 cases of gonorrhea detected in 2015.

Sexually transmitted diseases are seldom talked about because of the social stigma attached to them. Talking about them is awkward for the majority of people, and often the issue is just brushed off or suffered in silence. Many people choose to ignore the symptoms of the disease until it just can’t be avoided anymore or when complications arise. However, recognizing this issue is more important now than ever before and the looming threat of “super bug” STIs needs to be addressed.

Each time a person is diagnosed with gonorrhea, the doctor or local health authority involved in the diagnosis needs to report it to the federal government. Based on the number of reported cases, gonorrhea is the second most commonly reported notifiable disease in the United States, according to the Centers for Disease Control and Prevention (CDC). Minnesota ranks 34 among 50 states in gonorrhea infections with a total of 4,097 cases of gonorrhea detected in Minnesota in 2015, of which 35 percent were in Minneapolis alone. However, the disease is seldom talked about because of the social stigma attached to sexually transmitted diseases.

Many cases don't show symptoms

Gonorrhea can cause symptoms such as discharge or pain during urination, swelling of the scrotum and inflammation of the urethra. Complications of the disease, including narrowing of the urethra, infertility, inflammation of cervix and pelvic organs and ectopic pregnancy have far reaching and long-term consequences. Furthermore, many cases of gonorrhea don’t show symptoms of the disease and, as a result, people who have gonorrhea continue to spread the disease in the community without realizing it. In women, infections are more likely not to produce recognizable symptoms until complications have occurred. Extra genital sites such as rectum and throat are likely to harbor gonorrhea without any symptoms and prove to be reservoirs of infection. Patients with gonorrhea are also at increased risk for HIV infections.

There is a disproportionate prevalence of gonorrhea among racial minorities in Minneapolis. In comparison to the white population, the African-American population reported 16 times higher rate of gonorrhea infection. Sexual minorities such as homosexual men also have a disproportionately greater risk of sexually transmitted infections. Homophobia, the attitude of the majority population and a feeling of segregation and despair contribute to the alienation of the minority population from opportunities available to the majority population in access to health care.

Becoming resistant to antibiotics

Furthermore, gonorrhea is increasingly becoming resistant to antibiotics. As a reflection of this concern, a few years back the CDC updated its guidelines to recommend two antibiotics instead of one for the treatment of gonorrhea. For the first time in the United States, health officials have identified a cluster of gonorrhea infections that show decreased susceptibility and very high resistance to the two drugs that are currently used to treat the infection. This is a warning sign that gonorrhea treatment is losing effectiveness. In a recent CDC press release, the director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention said, "Our last line of defense against gonorrhea is weakening. If resistance continues to increase and spread, current treatment will ultimately fail and 800,000 Americans a year will be at risk for untreatable gonorrhoea."

We cannot continue to ignore the silent epidemic of gonorrhea in our community. Each undiagnosed and asymptomatic person with gonorrhea has the potential to spread the infection to many other people. A person may have gonorrhea and still exhibit no symptoms of the infection; thus screening of the high-risk and high-prevalence population is vital to combat the threat of gonorrhea. The increased prevalence of gonorrhea in racial minorities is a matter of grave concern. Unequal access to health care, lower educational attainment and residential segregation by race act as barriers to the removal of health disparities. These health disparities need to be eliminated to win the war against gonorrhea. The burden of new infections as well as the long-term complications have an adverse impact like increasing health care costs in this community widening the disparities further.

What we can do

We need to fight the war against gonorrhea at the individual, community, and societal level. As a society, we should be willing to talk about the dangers of STD with our children. Condoms need to be encouraged for oral sex as well. The Minnesota Department of Health needs to enhance systems for better screening of the diseases — especially in the communities and segments of the population that show a disproportionate prevalence of gonorrhea. The health department needs to invest in enhancing systems that monitor for emerging drug resistance and build rapid detection and response capacity to potential outbreaks of the multi-drug-resistant gonorrhea.

Aditya Kapoor is a health policy student at the University of Minnesota.

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