Plan B Forum

A team of Toronto doctors has identified the first cases of drug-resistant gonorrhea in North America, a startling discovery that is pushing health care officials across the continent into action.

“It’s taking a lot more drug to kill the bug,” said Dr. Vanessa Allen, a microbiologist and infectious diseases specialist at the Public Health Ontario Laboratories where she and her colleagues tested drug responses from nearly 300 patients who were treated at a Toronto clinic.

The research, lead by Allen and published this week in the Journal of the American Medical Association, found that 7 per cent of the Toronto patients failed to respond to cefixime — the last commercially available oral drug for gonorrhea. Antibiotics are considered ineffective when the rate of failure exceeds five per cent.

Responding to Allen’s findings, Ontario is developing its first set of guidelines for treating the sexually transmitted infection that is becoming increasingly prevalent and increasingly difficult to cure with an oral antibiotic alone.

The guidelines, due for release in March, will advise clinicians to treat the infection with an intramuscular injection as well as an oral pill. The new guidelines are similar to those unveiled by the Centres for Disease Control and Prevention in the United States.

While antibiotics have been successfully used to treat gonorrhea for decades, the CDC reports the bacteria has grown resistant to every drug ever used to treat it, including sulfonamides, penicillin, tetracycline, fluoroquinolones and finally the last class on the market — cephalosporins. Resistance had already been detected in Asia and Europe.

Symptoms in men include:

Burning and pain while urinating

Increased urinary frequency or urgency

Discharge from the penis (white, yellow, or green in color)

Red or swollen opening of penis (urethra)

Tender or swollen testicles

Sore throat (gonococcal pharyngitis)

Symptoms in women can be very mild or nonspecific, and may be mistaken for another type of infection. They include:

Vaginal discharge

Burning and pain while urinating

Increased urination

Sore throat

Painful sexual intercourse

Severe pain in lower abdomen (if the infection spreads to the fallopian tubes and stomach area)

Fever (if the infection spreads to the fallopian tubes and stomach area)

If the infection spreads to the bloodstream, fever, rash, and arthritis-like symptoms may occur.