Hawaii leads fight against drug-resistant gonorrhea
Federal officials now say that gonorrhea is among the "superbugs" resistant to common antibiotics and should be treated with a different class of drugs, something that was first discovered in Hawaii about eight years ago.
Officials from the Centers for Disease Control and Prevention recommended wider use of a different class of drugs yesterday to avert a public health crisis of the sexually transmitted disease.
But Peter Whiticar, chief of Hawaii's STD/AIDS Prevention Branch, said the first cases of gonorrhea resistant to antibiotics known as fluoroquinolones were reported in Hawaii in 1999, and alternative drugs were recommended.
"We're ahead of the curve because it happened here first and is working west to east," Whiticar said. "Recommendations (for treatment options) were created and tested here and are now being followed by the rest of the country."
The resistant form of gonorrhea accounts for more than one in every four cases among heterosexual men in Philadelphia and nearly that many in San Francisco, according to a survey that led to the CDC's recommendation.
Gonorrhea, which is believed to infect more than 700,000 people in the United States each year, can leave both men and women infertile and puts people at higher risk of getting the AIDS virus.
Since the early 1990s a class of drugs known as fluoroquinolones has provided a relatively easy cure. These antibiotics, taken as tablets, include the drug Cipro.
But a growing number of gonorrhea cases is resistant to those drugs, and officials at the CDC are urging doctors for the first time to stop using fluoroquinolones and switch to cephalosporins, a different class of antibiotics, to treat everyone.
"In Hawaii we discovered the inordinate level of resistant gonorrhea in 1999, and in 2000 we sent out a medical alert to all physicians," Whiticar said.
The state Department of Health changed its recommendation for treatment and stressed case management and "intense follow-up" of patients and their partners, Whiticar said.
"The big part is getting partners tested and treated as well," or the sexually transmitted disease continues to spread, he noted.
"There is a good relationship between the CDC and DOH in Hawaii and treating physicians," he said. "There is a need for good communications to them, and they've responded in a responsible way."
In 1997, Whiticar said, resistant gonorrhea cases in Hawaii comprised 1.4 percent of all cases. By 1999 the figure was up to 9.5 percent, in 2000 it was 11 percent and in 2001 it hit 19.6 percent, he said.
The medical alert, change in medicines and emphasis on case management and follow-up had a positive impact, he said.
Resistant gonorrhea cases went down to 9.2 percent of the total number by 2002 and 7.5 percent in 2003.
The number of gonorrhea cases declined from 1,193 cases in 2004 to 1,024 in 2005, but a higher proportion were resistant cases, Whiticar said. Resistant cases went up to 12.1 percent in 2004 and 13 percent in 2005, he said.
The Associated Press contributed to this report.