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Thursday, September 21, 2000

Resistant gonorrhea
rising in isles

By Pat Omandam

An increase in an antibiotic-resistant strain of gonorrhea in Hawaii is being reported by the Centers for Disease Control and Prevention in Atlanta.

This week's morbidity and mortality report from the CDC states there are more cases of fluoroquinolone-resistant gonorrhea reported in Hawaii. This line of antibiotics include ciprofloxacin and ofloxacin, front-line drugs used here to treat gonorrhea infections.

State health officials, however, respond that they have already advised health care providers here not to use that type of antibiotic and say other medications are available to treat gonorrhea.

"It is a problem in a sense that Hawaii physicians should not use that drug to treat gonorrhea in patients in Hawaii when they diagnose a case," said Dr. Philip P. Bruno, chief of Communicable Disease Division of the state Department of Health.

The report shows this drug-resistant strain of gonorrhea has increased in Hawaii to 9.5 percent in 1999 from 1.4 percent in 1997. As a result, the CDC recommends patients be treated with cefixime, an oral antibiotic, or ceftriaxone, an antibiotic administered by shot.

Both drugs are currently being used to treat gonorrhea, and no resistance has been reported, the center said.

"It is very easy and convenient to use this other medication, called ciprofloxacin, because you just give the medicine," Bruno said. "They swallow one dose and that's it."

Bruno said the 9.5 percent figure means that about 90 percent of the gonorrhea strains respond to treatment with fluoroquinolone antibiotics. But the only way to tell which strains are sensitive is to take a culture of each infection, which is done in only about half of the cases.

Bruno said there were 466 cases of gonorrhea in Hawaii last year, down from 507 cases in 1998.

As a result, the Health Department issued a medical alert on April 4 saying ciprofloxacin and ofloxacin should no longer be used to treat gonorrhea infections. Instead, it recommends the use of ceftriaxone, cefixime and spectinomycin, an alternative drug for those unable to tolerate the other two drugs.

The increase in the drug-resistant strain in Hawaii was discovered through a CDC-sponsored surveillance system that monitors drug-resistant gonorrhea through 26 sexually transmitted disease clinics across the country.

If not treated successfully, gonorrhea can cause pelvic inflammatory disease, infertility, ectopic pregnancy and chronic pelvic pain. Studies show gonorrhea can also make HIV transmission easier.

Gonorrhea is the second most common disease reported to the CDC, with more than 360,000 cases in 1999.

Bruno said Hawaii ranks among the bottom 10 states for the number of cases annually.

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