A form of the sexually transmitted infection gonorrhea that is resistant to all oral antibiotics has arrived in North America and health officials believe it is only a matter of time before it spreads to the U.S..  According to Reuters, a report issued on Monday said that seven percent of patients treated for gonorrhea in one Toronto, Ontario clinic did not respond to treatment with cefixime, the last known oral antibiotic used to fight the disease.

Last year, on Aug. 10, the CDC urged U.S. doctors and clinicians to stop using cefixime, sold under the brand name Suprax, to treat gonorrhea in order to head off the troubling rise in resistance.

"We've been very concerned about the threat of potentially untreatable gonorrhea in the United States," said Dr. Gail Bolan, director of the Centers for Disease Control (CDC)'s sexually transmitted diseases unit.  The only effective treatment remaining against the resistant strain is an injectable antibiotic called ceftriaxone.

U.S. and Canadian clinicians have been dreading the arrival of the disease since the first cases appeared in Europe.  Bolan told Reuters that the cases from the Toronto report are "the first time we've had such a report in the actual North American continent.  We feel it's only a matter of time until resistance will occur in the United States."

Dr. Vanessa Allen of Public Health Ontario in Canada said that Canadian physicians had seen one case before, but the study released on Monday marked the first published report.  Allen and her colleagues treated 300 patients for gonorrhea between May of 2010 and April 2011, then re-tested patients on return visits to see if they were still infected.

Of the original 300, 133 returned for retesting.  Of the 13 who were still infected, nine denied having any sexual contact which might have reinfected them, meaning cefixime had a 6.7 percent failure rate in this population.

Allen said that this is only a preliminary finding, but demonstrates that gonorrhea bacteria are acquiring resistance.

The Daily Mail quoted CDC official Robert Kirkcaldy, who wrote "[Cefixime] treatment failures have now been documented in North America.  Although this milestone was expected, its arrival is deeply troubling."

Gonorrhea infects approximately 600,000 Americans each year.  The disease manifests as drainage from the genitals, painful urination, abdominal pain, genital sores and itching.  Left untreated, the bacteria rages through the body, causing "pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies and infertility in both men and women."  Women infected with HIV and gonorrhea stand a much higher chance of passing HIV on to their children than women infected by HIV alone.

Dr. Allen noted that while patients infected with cefixime-resistant gonorrhea are not without hope -- they can be cured with injections of ceftriaxone combined with a course of oral azithromycin or doxycycline -- clinicians are seeing a rise of "parallel resistance" to ceftriaxone.

"I think without a doubt that this will become a bigger problem," she told the Mail.  "The next threat is when, not if, the same thing happens with ceftriaxone.  And then what?"

The CDC urges people with multiple sex partners to protect themselves by using condoms.  "Latex condoms, when used consistently and correctly, can reduce the risk of getting or giving gonorrhea."

[image via Wikipedia, creative commons licensed]