Over the past few years, STDs including syphilis, gonorrhea, and chlamydia, have been on the rise in both the U.S. and South Florida. And according to a recent report by the World Health Organization (WHO), these diseases are also becoming less treatable.
Antibiotics could typically take care of these three infections, but growing resistance to antibiotics and a lack of new drugs means doctors and patients could soon run out of treatment options.
Since 2013, the rate of syphilis infections reported in Miami-Dade and Broward counties has risen faster than the rest of the state and much of the nation. The two counties accounted for nearly 42 percent of the 5,340 syphilis cases reported in Florida from 2013-2015, according to the state health department. In Florida, syphilis infections continue to increase among gay and bisexual men. According to the state health department, more than 50 percent of these men are co-infected with HIV.
U.S. health officials also warned recently that like syphilis, gonorrhea appears to be developing resistance to the two antibiotics that constitute the last available treatment option for the sexually transmitted bacteria. Gonorrhea is a bacterial infection that spreads through unprotected vaginal, anal and oral sex. From 2013-2015, the number of gonorrhea cases in Miami-Dade and Broward counties accounted for about a quarter of the cases in Florida, according to the state health department.
“The emerging resistance to azithromycin is an early indicator that time is running out before the last recommended treatment for gonorrhea is no longer effective,” says Brian Katzowitz, Health Communication Specialist from the Centers for Disease Control and Prevention (CDC). “It’s vitally important for doctors to treat gonorrhea with dual therapy (azithromycin combined with ceftriaxone) and that individuals take steps to protect themselves. STD prevention is the cornerstone for containing antibiotic resistant gonorrhea.”
The WHO has released new guidelines on how to treat three sexually transmitted infections such as a single dose of benzathine penicillin to cure syphilis and continue to recommend doxycycline and azithromycin as the best choices to treat chlamydia. The WHO does not recommend quinolones (a class of antibiotic) for the treatment of gonorrhea due to widespread high levels of resistance. These new guidelines bring WHO in line with recommendations from the CDC that were issued in 2015.
Fort Lauderdale’s Dr. Gary Richmond treats patients with STDs. “To date, I have not seen multidrug resistant gonorrhea in my patient population,” he told SFGN. “Per guidelines, we treat our patients with dual therapy because of the emerging risk of drug resistance. Syphilis has always been more problematic within the HIV co-infected patient. Patients with latent syphilis frequently need retreatment for the initial infection. Benzathine penicillin is frequently on backorder and not available to treat syphilis infections. Often we are forced to use 2nd line therapy with tetracycline due to the drug shortage.”
The statistics for chlamydia are very similar to syphilis and gonorrhea. From 2013-2015, about 60,000 of the state’s nearly 255,000 cases were in Broward and Miami-Dade counties. While those numbers are huge, the spread of antibiotic-resistant STDs could have consequences that reach far beyond Florida. The WHO estimates that 131 million people in the world have chlamydia, 78 million have gonorrhea, and 5.6 million have syphilis. For women, these infections can increase the risk of miscarriage, ectopic pregnancy (when the fetus develops outside the womb), and pelvic inflammatory disease. For both men and women, they can contribute to infertility and increase susceptibility to HIV.
“I feel there is an emerging complacency regarding sexual disease transmission,” Dr. Richmond said. “With the availability and more frequent use of PrEP and misconception that HIV cannot be transmitted when one is on Highly Active Anti-Retroviral Therapy (HAART), individuals have stepped up their unsafe sexual practices, abandoning condoms and barrier precautions.”
Recently in Hawaii, seven gonorrhea patients had the first reported cases of gonorrhea in which the sexually transmitted infection showed reduced susceptibility to the single available effective treatment option, the Centers for Disease Control and Prevention said. The six men and one woman were all eventually cured by ceftriaxone and azithromycin, the two-drug regimen recommended for treating gonorrhea by the CDC. However, laboratory tests by the Hawaii State Department of Health showed that the patients' gonorrheal infections did not succumb as easily to the antibiotics as infections have in the past.
Someday, these antibiotics may no longer work to cure gonorrhea, which, over the years, has developed resistance to nearly every class of antibiotics used to treat it.
So far, no cases of drug resistant sexually transmitted infections in Florida.” We are closely monitoring this situation and have been working with labs to ensure they are routinely testing specimens for drug susceptibility,” said Sarah Revell of the Florida Department of Health.
The CDC will be bolstering state and local STD programs and introducing laboratory tools and services to more rapidly respond to outbreaks. When asked to describe what it would be like if syphilis, gonorrhea and chlamydia became completely resistant to antibiotics, Dr. Richmond had one word, “disastrous.”