Las Vegas part of national study on gonorrhea drugs

Thursday, Dec. 12, 2002 | 10:49 a.m.

The Clark County Health District has joined a federal study to determine why modern drugs used to treat gonorrhea may not be working.

The Centers for Disease Control and Prevention in Atlanta asked the district to make Las Vegas one of 25 cities to take part in the study, which is part of a larger nationwide gonorrhea investigation that began in 1986, Clark County Health District Public Health Nurse Manager Mary Ellen Harrell said.

"We were asked to join because of our geographical closeness to California and Hawaii, which have had higher incidents of antibiotic resistance to gonorrhea drugs," Harrell said.

The Clark County Health District was given $5,000 to join the study. Harrell said most of that money was spent on a special refrigerator to store the 25 to 30 gonorrhea samples that the Health District must submit each month to the CDC. No end date has been set for Las Vegas' involvement in the study, Harrell said.

Only men are being sampled for the study at the health district's Sexually Transmitted Disease Clinic because gonorrhea is easier to diagnose in men. Men have telltale symptoms while women often have no symptoms, Harrell said.

Last year the health district had a five-year high of 1,836 gonorrhea cases. Through November of this year 1,604 cases have been recorded. If that pace continues, this year will be slightly below last year.

Treatment of gonorrhea has changed significantly over the years. Tetracycline, commonly used many years ago, was effective but patients had difficulty tolerating it, Harrell said.

Modern drugs called fluoroquinolones are much easier on the system, and include Cipro and Levaquin. But those are the drugs to which a resistance apparently has developed, officials said.

Dr. Raymond Mondora, a Las Vegas family practitioner, says he has read medical papers on what has happened in Hawaii and California, but has not seen a drug resistance in the patients he has treated with Levaquin.

"I've been looking for it, but I've not heard from patients so I can only assume that Levaquin has worked," he said. "It is alarming that there has been resistance reported but it also was predictable. There are a lot of infections for which there has been a resistance to today's antibiotics."

Mondora and Harrell said one problem is that some people take antibiotics until they feel better then save the rest of the pills in case they get sick again. Patients who do that actually build up a resistance to the drugs.

"I think it's great the local health district has joined the CDC in this study," Mondora said. "I'd hope that one of the things we might learn is if other bacteria is involved. I'd like to see more data on whether there are mixed infections."

The Health District uses the single-dose injections of cedixime and rocephin to cure gonorrhea. Harrell says most doctors see so few cases of gonorrhea that it is not practical or cost-effective for them to keep such injections in stock.

Mondora, who sees maybe one case of gonorrhea or less per 100 patients, agrees, noting he used to keep rocephin in stock, but now prescribes the pills.

"People don't like shots -- they'd rather take their medicine orally," he said. "I came here from Michigan, and I treated far more cases of gonorrhea in Detroit 12 years ago than I do in Las Vegas today.

The CDC study has, over the years, found that the highest incidences of gonorrhea occur in high-density urban areas among persons under age 24 who have multiple sex partners and engage in unprotected sex. Also, gonorrhea has been more prevalent recently among homosexual men, according to the CDC.

Overall, however, gonorrhea has been on the decline nationwide since 1987. Reported cases of gonorrhea climbed steadily from 1964 to 1977 then fluctuated through the 1980s. In 1997, 324,901 cases were reported nationwide, the CDC said.

If left untreated, gonorrhea can lead to infertility, arthritis and endocarditis, which is an inflammation of the heart, Harrell said. Gonorrhea also can weaken a person's immune system, making him or her more susceptible to incurable and fatal diseases like AIDS and hepatitis.

Gonorrhea is transmitted only through sex. It cannot be transmitted through items like a toilet seat or by using a towel that an infected person used, Harrell said.

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