Big Bug Blues: UK Man Contracts Super-drug-resistant Gonorrhea As Scarlet Fever Rages There, and Then There’s the CDCUP -- UPDATE: A User's Guide to Dodging the Clap

Communicable Diseases 772 views
Written by Timothy Pfaff

Great Britain clocks the first case of a super-drug-resistant strain of gonorrhea, apparently contracted in SE Asia, as scarlet fever cases there continue to spike while America Brexits: Donald Trump’s new appointment to head the CDC sparks predictable controversy. FOR A HELPFUL UPDATE, go to the end of this post.

Big Bug Blues: UK Man Contracts Super-drug-resistant Gonorrhea As Scarlet Fever Rages There, and Then There’s the CDCUP -- UPDATE: A User's Guide to Dodging the Clap

No one in need of cheering up turns to infectious-disease news, but that doesn’t reduce the need for it. Anyone informed might turn out to be someone spared. As CNN anchor Chris Cuomo likes to say, “Let’s get at it.”

Gonorrhea

In a previous post here we wrote of a possible vaccine against gonorrhea, hopeful at any time but however welcome in advance, possibly too late. The dreaded clap, whose relentless progress has been slowed only by people in communities that insist on condom use, is back in strains that are proving drug resistant.

Well, what CNN is calling a “super-drug-resistant” strain of gonorrhea has arrived in the UK via a tourist who caught it in Southeast Asia. We in Southeast Asia have a hard time not saying, “in Southeast Asia of course.”

In a story on its website on March 28, “First case of super-resistant gonorrhea reported,” Meera Senthilingam reported that Public Health England is investigating the first case of a strain of gonorrhea that is resistant to the first-line treatment for gonorrhea. That treatment, a combination of two antibiotics (azithromycin and ceftriaxone), has met high-level resistance in a man who says he contracted it in Southeast Asia a month before symptoms appeared.

The heterosexual man, who has a regular sex partner in the UK, himself claims to have contracted Neisseria gonorrhoeae a month before seeking treatment of his symptoms in the UK public health system. He has been treated with intravenous ertapenem, an antibiotic that appears to be working, in CNN’s words, “for now.” It wil be a month before it's known whether the treatment is successful.

CNN’s story also quoted David Harvey, executive director of the National Coalition of STD Directors at the U.S. Centers for Disease Control and Prevention, thus:

“This report is one more confirmation of our greatest fear: drug-resistant gonorrhea spreading around the globe. Here in the US and around the globe, we have to take drug-resistant gonorrhea seriously in order to invest in finding new cures and preventing infections. Working together, funding must be radically increased to combat this and other life-threatening STDs."

The concise official report by Public Health England is here.

Trying to keep up: Since we posted the above a half hour ago, the BBC has weighed in with its story, calling it the "worst-ever" case of gonorrhea, reported by James Gallagher, at http://www.bbc.com/news/health-43571120. In that story, the BBC quoted Dr. Olwen Williams, president of the British Association for Sexual Hwealth and HIV thus:

"We are concerned that the problem will worsen due to the dramatic cuts that have been delivered to the public health budget. Worryingly, this has left sexual health services at 'tipping point', with clinic closures coming at the worst possible time."

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Scarlet fever

If you’re watching the Brexit news, one of the things you know is that the UK’s long-imperiled National Health Service has moved into a crisis phase that appears only to be increasing. In addition to declining government funds for the national health program, non-British medical health professionals, vital to the system, are leaving in droves because of current or impending work visa considerations.

Meanwhile, an outbreak of scarlet fever we wrote about in a recent post here is seeing an upwardly spiraling number of cases. In a March 27 story by Senthilingam and Sandee LaMotte on its website, it is again CNN that reports, “Health agency warns UK parents as scarlet fever cases soar.”

Between mid-September and the week ending March 18, more than 15,370 cases of scarlet fever have been reported by Public Health England (PHE). The 20,000 cases in the whole of 2016 marked a “fifty-year high.” Quoted in the article, Nick Phin, PHE deputy director commented, "Greater awareness and improved reporting practices may have contributed to this increase." 

Treatable by antibiotics if caught early, scarlet fever is nonetheless highly contagious and particularly in children ten years old and less, or school-age.

In a previous report by CNN, Theresa Lamagni, a senior epidemiologist at PHE, commented, “Guidance on management of outbreaks in schools and nurseries has just been updated, and research continues to further investigate the rise. We encourage parents to be aware of the symptoms of scarlet fever and to contact their (general practitioner) if they think their child might have it."

The symptoms of scarlet fever are described in both CNN reports and can be read here.

Changes at the CDC

In our post of a month ago, we noted that the U.S. Centers for Disease Control and Prevention (CDC) has been increasingly imperiled by reduced funding and transitory leadership by the Trump administration. At the end of January, Dr. Brenda Fitzgerald resigned as the agency’s director for reasons of financial “conflict of interest.”

All eyes were on the then-incoming new secretary of the overseeing Department of Health and Human Services Alex Azar. For his part, Azar was replacing Dr. Tom Price, who resigned under a cloud of fiscal-malfeasance allegations.

On March 23, Foreign Policy reported, under the headline “Meet Trump’s New, Homophobic Public Health Quack,” the appointment of Fitzgerald’s replacement. In another turn toward military appointments, Trump has named to the position Robert Redfield, a retired U.S. Army lieutenant colonel and former University of Maryland opioids and AIDS researcher. Foreign Policy was unsparing in its assessment of the appointment:

“He is exactly the wrong person for the job. Amid an exploding influenza epidemic across the United States, an opioids crisis that has decreased the statistical life expectancy of Americans, and a budget crisis that twice compelled closure of critical laboratory and disease-fighting services, the CDC desperately needs a leader who can promise stability and expertise. Redfield represents the opposite; he is someone whose track record in HIV research and public health policy has been a scientific and moral failure.”

Its detailed account of Redfield’s professional, laregly military, past is chilling.

In more measured language but with a similar expose of Dr. Redfield’s controversial past regarding the treatment of HIV, on March 21 the Washington Post announced his appointment, calling him “well respected for his clinical work but has no experience running a governmental public-health agency.”

In its March 21 story, the New York Times wrote of Dr. Redfield’s appointment to head the CDC, “News of Dr. Redfield’s appointment has revived criticisms about some of his policy stances and research practices that date back to an earlier period in the AIDS epidemic. He came under fire for advocating broad AIDS testing and the screening of military personnel for the virus.

“In addition, his research into a potential treatment vaccine led to allegations of data distortion and a military investigation; no evidence of misconduct was found. His record has prompted Senator Patty Murray, the ranking Democrat on the health committee, to oppose his appointment, although some advocates for AIDS patients now say they support him for the job.”

In its article about the appointment, The Atlantic, itself the center of a controversy about a new appointment to its editorial team (the hiring of conservative commentator Kevin Williamson, who has opined, among other outrages, that women who have had obaortions should be hanged), went into more detail about the appointee’s controversial past (verbatim):

“Redfield has not escaped the controversy that has dogged other Trump-era appointees. In the mid-1990s, Redfield oversaw a clinical trial of an experimental HIV vaccine at the Walter Reed Army Institute of Research. He was accused of manipulating data from the trial, “sloppy or, possibly, deceptive” data analysis, and overstating results in a number of talks and publications. After an investigation, the military cleared Redfield of misconduct charges, but as Jon Cohen reported for Science at the time, the Army never provided an explanation of how it reached its conclusions.

“Despite clearing him, military investigators chastised Redfield for having a “close relationship” to a nonprofit called Americans for Sound AIDS/HIV Policy (ASAP) “to a degree that is inappropriate.” ASAP, now known as the Children’s AIDS Fund, was founded by evangelical Christians; it has championed abstinence-only education as a method of combating HIV and other approaches grounded more in religious belief than scientific evidence.

“Redfield also has a history of supporting other contentious HIV-related policies.”

At the Veterans Administration

The appointment pre-echoed Trump’s stunningly surprise March 28 appointment—which his advisers had opposed—of the White House physician, Dr. Ronny L. Jackson, who had served previous presidents in the same capacity, as the new head the Veteran’s Administration. In a wave of high-level firings, Trump had, that day, dismissed Dr. David Shulkin by Tweet, having spoken with him about policy on the phone hours earlier.

Dr. Jackson’s animated report to the press of the superb results of his examination of the President was sufficiently over the top to become a Saturday Night Live skit post haste. While no one actually begrudges Dr. Jackson’s qualifications as a physician, his complete lack of administrative experience makes him a worry as the new head of the second-largest bureaucracy in the U.S. government, which has a staff of 370,000 and the nation's second-highest agency budget.

It was widely feared that the appointment of Dr. Jackson would help pave the way for the increasing, if not total, privatization of the Veterans Administration, which the GOP has long sought and veterans organizations strongly opposed. Dr. Shulkin wrote a New York Times op-ed piece warning of the same the day after his firing.

Additional reports are listed in the Sources/Reading section below.

So….

It would appear that the Trump administration’s message to U.S. citizens, its veterans, and the people around the world whose work the CDC has in the past deeply affected, is: Behave. Be well. Stay well.

UPDATE:

News about the first case of drug-resistant “super” gonorrhea has hit the health-conscious LGBTQ community hard, with its press springing into action. A new and helpfully concrete what-it-is, how-to-respond post on towleroad.com tells its readers:

“While the patient with the untreatable case picked it up from a sexual encounter with a woman in Southeast Asia, it could just have easily been transmitted by male-to-male contact, and for that reason, gay men should be aware that it’s out there, and know about precautions to be taken.”

Gonorrhea has never discriminated on the basis of sexual orientation or behavior, so we’re recapping the “precautions to be taken” as universally applicable. In terms of contracting gonorrhea, there’s nothing gay men do that heterosexuals don’t also do. (Of course, in both cases, we mean "some.")

In its brief coverage of the consequences of untreated gonorrhea, blog master Andy Towle adds, “Untreated gonorrhea may also enhance your chances of getting or giving HIV.” His post links to two YouTube videos, one on anal discharges and the other on contraction of gonorrhea orally, that are targeted at seuxally active gay men but are equally relevant to people of all active sexualities.

After noting that a particular problem with gonorrhea is that a person with it may not show symptoms, as we have noted in our post, Towle quotes Bruce Y. Lee, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health. Here are Lee’s comments verbatim:

"One problem is unprotected oral sex. Remember, unprotected oral sex is not 'safe sex.' (You know the joke that the only safe unprotected sex is when you are in different zip codes.) Oral sex can transmit Neisseria gonorrhoeae from someone’s privates to your throat and vice versa. And up to 90% of people with oral gonorrhea have no or minimal symptoms….

“Even if you do develop symptoms, the symptoms can be hard to distinguish from typical symptoms of other types of throat infections such as strep throat (another name for streptococcal pharyngitis): sore throat, difficulty swallowing and redness of the throat. Symptoms typically emerge one to three weeks after the initial infection.

“Then, if your doctor doesn’t test you for strep throat when you actually have ‘gonorrhea throat’ and instead automatically gives you antibiotics, the antibiotics can then select for antibiotic-resistant gonorrhea. You can then pass antibiotic-resistant gonorrhea to someone else’s privates through oral sex. This is the circle of life for super gonorrhea.”

Towle also takes up, at considerable length the disputed “risk” of passing gonorrhea through “French kissing.” Our quick summary: unlikely; don’t panic / like the doctor says, oral sex is not necessarily “safe sex”; when in doubt, don’t.

Near the end of his post, Towle writes: “The depressing news is that the best way to prevent oral gonorrhea involves using a condom during oral sex. We’d venture to guess this doesn’t happen most of the time.” A word to the wise of any persuasion. 

Sources/Reading:

Gonorrhea

https://edition.cnn.com/2018/03/28/health/uk-man-multidrug-resistant-gonorrhea-intl/index.html

https://www.gov.uk/government/publications/multi-drug-resistant-gonorrhoea-in-england-2018

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/694655/hpr1118_MDRGC.pdf

https://www.cdc.gov/std/gonorrhea/arg/default.htm

http://www.bbc.com/news/health-43571120

http://www.towleroad.com/2018/04/gonorrhea-gay/

Scarlet fever

https://edition.cnn.com/2018/03/27/health/scarlet-fever-surge-in-cases-uk-intl/index.html

New man at CDC

http://foreignpolicy.com/2018/03/23/meet-trumps-new-homophobic-public-health-quack/

https://www.washingtonpost.com/news/to-your-health/wp/2018/03/21/longtime-aids-researcher-robert-redfield-picked-to-lead-cdc/

https://www.nytimes.com/2018/03/21/health/cdc-robert-redfield-aids.html

https://www.theatlantic.com/science/archive/2018/03/trumps-pick-for-cdc-director-is-experienced-but-controversial/556202/

http://time.com/5211143/robert-redfield-cdc-director/

http://www.sciencemag.org/news/2018/03/trumps-pick-lead-cdc-both-celebrated-and-censured

https://www.medscape.com/viewarticle/894309

https://www.scientificamerican.com/article/virologist-robert-redfield-named-as-next-cdc-director/

 

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