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February 2023 Advice to Be Well From Dr. Mark Bornstein and Dr. Paul Benson

My friend told me about a new strain of gonorrhea that is difficult to treat.  I have not heard of this.  Is it true? – M.B.

Dear MB

Gonorrhea is the second most common sexually transmitted infection in the United States.  Chlamydia is the most commonly reported.  Gonorrhea can be contracted vaginally, rectally, orally, and in the urethra.  It may or may not be associated with symptoms.  These symptoms can include, discharges, pain, difficulty urinating, and others.  Sometimes, if left untreated or incompletely treated, it can progress to arthritis symptoms, and in women pelvic inflammatory disease.  It is not unusual that symptoms are mild or absent; If so, the person infected is a carrier of the infection without knowing it.  Risk reduction can be accomplished with condom usage.

Two cases In the United States have recently been identified as being a new strain of gonorrhea.  This new strain has developed at least some resistance to several accepted antibiotic treatments for Gonorrhea.  Currently, the standard of care treatment for gonorrhea is injectable ceftriaxone (Rocephin).  It has enough sensitivity to treat this strain.  The standard of care since 2012 is to treat Gonorrhea with both ceftriaxone and azithromycin.  This would then be acceptable treatment for Chlamydia, if it was co-existing with Gonorrhea, and give an additional boost to the ceftriaxone.  Treatment for Gonorrhea has changed over the years due to emerging resistance.  In the late 1990’s we were using an oral one-time dose of Ampicillin.  We don’t use that any longer due to Gonorrhea’s resistance to Ampicillin.

Antimicrobial-resistance to Gonorrhea is a public threat both nationally and internationally too.  New drugs to combat emerging resistance are being developed.  Vaccinations for Gonorrhea are in development.  The Be Well Medical Center, was preparing to be a site for this investigation, however that study was put on hold for the time being.  Timely identification and treatment are essential in reducing transmission.  All sexually active people are advised to be tested regularly for sexually transmitted infections. 

Hi Doctor, my partner just tested positive for mycoplasma genitalium. I’ve never heard of this before. Is it a sexually transmitted infection (STI)? What should I do? – JB

This is a great question. Mycoplasma genitalium (Mgen) can be confusing as it is a bacteria that many people have never heard of. In fact, many clinics do not even test for this bacterium in routine STI testing. It is important to know if your clinic tests for this 

Mgen is a bacteria that folks can get during sex. It is considered an STI in the sense that if it goes untreated, it can cause urethritis (painful urination, discharge, etc.) and pelvic inflammatory disease in folks with a uterus. Just like other STI’s, one can get have this colonize at any body part that they use for sex including your throat, genitals, and anus. That being said, many folks can test positive for Mgen and have zero symptoms. This is actually quite common. If one does have symptoms, they usually consist of either burning with urination or discharge. 

Traditionally, Mgen has been difficult to treat. It commonly is resistant to certain antibiotics and if you and your partner are not treated at the same time, you can continue to pass it back and forth after you had been successfully treated. This is why it is essential to know if you and your partners clinic tests for this bacteria. Furthermore, it is important to know if your clinic runs resistance testing if one tests positive. Mgen used to be treated with azithromycin although now the guidelines have changed due to resistance towards this antibiotic and is now treated with two different antibiotics. If resistance testing is done and the infection is sensitive to azithromyzin, it is treated with doxycycline for 1 week and then azithromycin for 3 days. If resistance testing is done and it shows that it is resistant to azithromycin, it is treated with doxycycline for 1 week and then moxifloxacin for 1 week. This is a lot of antibiotics for your system, so many providers will choose to treat with only moxifloxacin for 1 week which typically works as well.

Please reach out if you have any more questions on Mgen. At Be Well Medical Center, not only do we test for Mgen on all routine STI screenings, but we also test for resistance to antibiotics. Sex is a very important part of your health and we are committed to helping you do this in a safe way.

Since 1980 Dr. Paul Benson’s Be Well Medical Center has been an inclusive medical center celebrating diversity. Do you have a health related question for Dr. Paul Benson and Dr. Mark Bornstein? Submit your questions to [email protected]. This article is a sponsored editorial produced in collaboration with Be Well Medical Center. Between The Lines’s journalism is made possible with the support and partnership of advertisers like Be Well. Learn more about Be Well here.

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