Mutant Syphilis Strain Resists Cure
Thomas McGovern
Psychology
Introduction
In this website I will show the symptoms, treatments and potential long term effects of many Sexually Transmitted Diseases, as well as the growing problem of Antibiotic Resistance some of these diseases are forming to known treatments. Over-prescription and careless use of once effective antibiotics has potentially disastrous repercussions on the Medical world. The occurrence of resistant bacteria is becoming much more widespread with each study that is done.
Syphilis (Treponema Pallidum)
Syphilis is a highly contagious disease spread primarily through sexual activity including oral and anal sex. Occasionally, the disease can be passed on to another person through prolonged kissing or close bodily contact with an infected person. Pregnant women with the disease can spread it to their baby, this is called Congenital Syphilis. Congenital Syphilis can cause abnormalities or even death to the child. Nearly half of all babies infected during gestation die shortly after or before birth. (NLM/NIH) Children who survive will have problems later on in their development. These problems include:
Tooth Abnormalities (Hutchinson Teeth)
Saddle-nose Deformities from infections in the cartilage
Syphilis infection occurs in 3 distinct stages:
Early or Primary Syphilis- Often referred to as the "great imitator" because it can be mistaken for many other conditions. Infected will develop one or more chancre sores that resemble large round bug bites, and are often hard and painless. Chancres occur on the genitals or in or around the mouth between 10-90 days after exposure, and heal without a scar within 6 weeks.
Secondary Stage- This stage begins within 6 weeks to 6 months after exposure and may last 1-3 months. Infected experience a rosy "copper penny" rash typically on the palms of the hands and soles of the feet. They may also experience moist warts in the groin, white patches on the inside of the mouth, swollen lymph glands, fever, and weight loss.
Tertiary Syphilis- If the infection isn't treated, it may then progress to a stage characterized by severe problems with the heart, brain, and nerves that can result in blindness, dementia, impotency, and even death if its not treated.
Syphilis can be easily diagnosed with a quick and inexpensive blood test given at your doctor's office or at a public health clinic. If you have a chancre, your doctor will take a swab or scraping of the sore. It will then be sent to a lab to analyze under a microscope for the characteristic bacteria.
The recent problems in the treatment for syphilis is what spawned this topic. If you've been infected for less then a year, a single dose of penicillin is usually enough to destroy the infection. If you are in later stages, more doses will be needed. While this penicillin has long been the recommended treatment for syphilis, patients have long complained about the treatment being painful. It must be given in two buttocks injections much more painful than typical shots, because of the large amount of the solution that must be forced into the muscle.
Since the late 1990's doctors and clinicians have been giving a different antibiotic, azithromycin (commonly known as Zithromax), to many syphilis patients because the long acting antibiotic was highly effective and easy to use. Azithromycin is a very commonly prescribed antibiotic, because it is used to treat many different types of bacterial infections. It is prescribed for bronchitis, pneumonia, tonsillitis, skin infections, and ear infections as well as sexually transmitted diseases. The most important thing about treating an illness with azitromycin is that all of the prescription must be taken. This includes continuing the treatment even after you begin to feel better or your symptoms improve. This feeling better shortly into the prescription does not mean you are cured, but it could lead to a much larger, more alarming problems. Largely in part to many ill patients not completing their prescriptions, the stronger bacteria that was not killed by the antibiotic continues to live in the system. I will go more into how bacteria becomes resistant a little further down the page.
In an article written by the associated press and printed in many publications on July 8, 2004 entitled: "Antibiotic-resistant syphilis spreading," The New England Journal of Medicine reported a study by researchers at the University of Washington saying that at least 28% of syphilis samples from patients at sexually transmitted disease clinics in four cities had a strain resistant to azithromycin. "That suggests that this mutation is pretty widely distributed geographically" said Sheila Lukehart, research professor of infectious diseases. Ms. Lukehart studied 114 syphilis samples from Seattle, San Francisco, Baltimore and Dublin, Ireland, finding 28% were resistant to azithromycin, including 88% of the Dublin samples. Of the very high Dublin figures, Dr. Fiona Mulcahy, consultant in genito-urinary medicine at St. James Hospital in Dublin, said "Ireland would have a very pure MSM (men who have sex with men) group. It's concentrated around a small number of venues." She also added that part of the reason for the emergence of a resistant strain of syphilis could be the increased use of antibiotics generally in society.
Stateside, the numbers are also disturbing. The strain is spreading rapidly in San Francisco, where it jumped from 4% of patients in 1999-2002 to 37% in 2003. In Baltimore, Maryland the incidence of the new strain among syphilis sufferers was 11% and in Seattle, Washington the incidence was 13%. More Generally around the country the outlook for syphilis has changed quite a bit. According to the Center for Disease Control and Prevention, Syphilis decreased in the United States through the 1990's, then climbed 19% from 2000-2003 to about 7,100 cases. The CDC attributed the spike to a twelve-fold rise in cases among gay and bisexual men, many of whom are also infected with the AIDS virus. In their condition, with their immune systems depleted, it is easy to see how strong bacteria would be able to live inside their bodies.
Unfortunately, Syphilis is not the only Sexually Transmitted Disease to recently show antibiotic resistance. Gonorrhea has made a resurgence in the U.S. and has shown alarming rates of resistance to common Antibiotics.
Gonorrhea (Neisseria gonorrhoeae)
Gonorrhea is a bacterial infection of the urethra in men and the urethra, the cervix, or both in women. It can also infect the rectum, the throat, the pelvic organs, and rarely, the conjunctiva, the membrane that lines the eyelid and eye surface. Common nicknames for the infection are the Clap, Drip, or GC. Gonorrhea can be spread during vaginal, anal, or oral sex with an infected partner. A pregnant woman can pass the infection to her newborn during delivery. Gonorrhea can be transmitted any time by an infected person, symptoms present or not. The infected are contagious until he or she has been treated.
Gonorrhea is the second most reported sexually transmitted disease (behind Chlamydial infections) in the United States. Annually, it is reported in around 600,000 people, and its believed that another 1 million cases go unreported each year. Approximately 75% of all cases of gonorrhea reported by health professionals to the Centers for Disease Control and Prevention (CDC) are in people 15 to 29 years old. Teenage girls ages 15-19 and men ages 20-24 have the highest rate of infection.
About half of those infected don't have symptoms. People who do not have symptoms may unknowingly transmit gonorrhea infections to their sex partners. If symptoms are present, they may include painful urination; anal itching or bleeding, or abnormal discharge from the urethra in men or from the urethra, the cervix or both in women. The throat anus and rectum are common in both men and women. In men, symptoms are usually serious enough that they will seek medical evaluation before complications occur. In women, the early symptoms are sometimes so mild that they are mistaken for a bladder infection or vaginal infection.
Gonorrhea, like syphilis, is treated with antibiotics. Antibiotic treatment, if taken exactly as directed, normally cures gonorrhea infections over 97% of the time. If antibiotics are not taken properly, the infection will not be cured. Prompt antibiotic treatment also prevents the spread of the infection and decreases complications, such as pelvic inflammatory disease. Abstinence from sexual contact is a must while being treated for any STD. People taking a single dose of medication should abstain from sexual contact for 7 days after treatment so the medication will be effective. Exposed sexual partners within the last 60 days need to be tested and treated whether they have symptoms or not.
Gonorrhea has also taken a turn for the worse, and has mutated into many strains that are resistant to common antibiotic cure. According to a Washington (DC) Times article written by Joyce Howard Pryce, Dr. John Douglas, director of the U.S. Centers for Disease Control and Prevention's STD prevention programs, "National and regional data show the drug-resistant gonorrhea is a rapidly emerging health concern, particularly for gay and bisexual men." The sharp rise in gonorrhea that is resistant to oral antibiotics known as fluoroquinolones, including Cipro (ciprofloxacin), CDC officials advised homosexual and bisexual men against using such drugs as a first-line treatment. Dr. Douglas said heterosexuals can continue to use fluoroquinolones, which have been popular because they are cheap, available in pill form and taken in single doses, to treat gonorrhea because of the low incidence rate of the antibiotic resistance among that population.
Some suggest that the homosexual and bisexual population may be relaxing safe-sex practices, using illegal substances such as crystal methamphetamines that disrupt judgment, and meeting more sexual partners over the Internet. Also, with the arrival of potent drugs to control HIV infections, AIDS no longer commands the fear it once did. Charles Dwyer, manager of HIV services at the Maine Bureau of Health, says the result can be witnessed on any Saturday night. "Ten years ago, at places like bars where people would go or hook-ups, it was not uncommon for people to have an automatic understanding that condoms would be used," he said. "It's not that way anymore."
Regional data support national findings that drug-resistant gonorrhea is primarily a problem of homosexual and bisexual men. The Massachusetts State Laboratory Institute said that from January through August last year, the condition was identified more then six times more often in Homosexual and Bisexual men(11.1%) then Heterosexual men (1.8%). Similarly, New York City's Department of Health found drug-resistant gonorrhea nearly eight times more common among men whose sex partners are male (12.5%) than among heterosexuals (1.6%).
Bacterial Resistance
In this section, I hope to briefly explain how bacteria can become resistant to antibiotics. Though brainless, these bacteria are capable of thwarting the scientists' best efforts to destroy them. This skill is more genetic ability then intellect. As single-celled organisms, bacteria divide many times a day, and every division provides an opportunity for a DNA mutation. Some mutations create new genes that are harmful to the bacteria and others result in changes that are beneficial. Bacteria can also occasionally pick up a few new genes from their fellow bacteria. They can do so through conjugation. Conjugation is a primitive form of sexual activity in which two cells join together and, in the process, may exchange plasmids, or gene-carrying structures outside the chromosomes. Some genes enable the bacteria to make proteins like penicillinase, which deactivate antibiotics. Other proteins serve as pumps to clear antibiotics out of the bacterium before the drugs have a chance to do any damage. Genetic changes may also alter structural proteins that once served as entry or attachment sites for antibiotics, effectively locking the cellular doorway to these drugs.
Resistant bacteria usually constitute a very small percentage of the bacterial population and are generally slower growing than their non-resistant counterparts. However, when antibiotics come into play, the scene changes. Most of the bacteria are wiped out, but the fraction that carry the resistance strain survive to reproduce. If the resistant bacteria become numerous enough to make themselves known, or produce pain, fever, or other signs of infection, the original antibiotic is likely to be prescribed again. This time it will not work as well, because more of the bacteria are impervious to its effects. Drugs that were once considered fail-safe have been rendered ineffective. For example, Trimethoprim was once a universally cheap and reliable treatment for diarrhea is now unusable in many parts of the world. In most cases, bacteria that are resistant to one drug can be eliminated with another one. Eventually, strains that are resistant to the second antibiotic will spring up. This was the case with ciprofloxacin (Cipro). Designed to wipe out several different types of bacteria, within months after it went on the market, medical journals began to carry reports of Cipro-resistant bacteria (see above Gonorrhea).
Fortunately, this situation can be corrected. When antibiotics are not used for a time, the slower-growing resistant strains lose their advantage and are gradually eliminated. An increased awareness of this problem is now common throughout the medical community. The CDC has launched a series of public service announcements to curb over prescription and demanding for antibiotics. The campaign entitled "Get Smart: Know When Antibiotics Work" will feature an owl mascot with a stethoscope in an attempt to counter Max the Zithromax Zebra.
Works Cited
1. "Syphilis" Charlotte E. Grayson, MD The Cleveland Clinic Department of Obstetrics and Gynecology Oct. 2003
www.my.webmd.com/content/article/46/2953_58.htm
2. "Syphilis." Center for Disease Control. May 2, 2003 www.cdc.gov
3. "Bacteria.” Microsoft Encarta Online Encyclopedia. 2003. Microsoft Corporation. 30 Aug. 2003. http://encarta.msn.com/encnet/refpages/RefArticle.aspx?refid=761574409.
4."Congenital Syphilis" Medline Plus 7/30/2002 http://www.nlm.nih.gov/medlineplus/ency/article/001344.htm
5. "Azithromycin" Cerner Multum, Inc. Version: 6.04 2/13/04 www.my.webmd.com/hw/drug_data
6. "Antibacterial Overkill" Tufts University Health & Nutrition Letter, Oct98, vol. 16 Issue 8, p1, 3p
7. "Antibiotic resistance" Harvard Women's Health Watch, April 97, vol. 4 issue 8 p2, 2p
8. "New mutant strain of syphilis detected in Dublin Tests" Sean O'Driscoll and Joe Humphreys
The Irish Times, 7/10/2004
9."Antibiotic-resistant syphilis spreading" Associated Press July 8, 2004
10. "Gonorrhea" Center for Disease Control. October 18, 2001
11. "Gonorrhea" Medline Plus 8/5/2002 http://www.nlm.nih.gov/medlineplus/ency/article/000656.htm
12. "Drug Resistant Gonorrhea Spikes" Joyce Howard Price, April 30, 2004, The Washington Times (DC) pg. A11
13."Resistant form of Gonorrhea gains in Mass." Stephen Smith, March 10 2004, The Boston Globe (MA) pg A1
14. "Drug-Resistant Gonorrhea Found" Nancy McVicar, April 30, 2004, South Florida Sun-Sentinel pg. 8A