The fear of contracting AIDS has gripped North Americans since the early 1980s. And partly because of the massive health education campaigns that grew out of those concerns, the incidence of gonorrhea, the most common sexually transmitted disease in Canada, has decreased dramatically since 1982. The number had dropped to 35,287 in 1986 from a reported 53,076 cases in 1982. But now health officials say that they are increasingly concerned about an increase in the incidence of a new strain of the
disease. Called penicillinase-producing neisseria gonorrhoea (PPNG), the strain is resistant to penicillin—the most common and least expensive treatment for gonorrhea. In 1986, 460 cases of PPNG were reported in Canada—a number more than four times higher than in 1982. And, according to Dr. JoAnne Dillon of the Ottawa-based Laboratory Centre for Disease Control, “the situation is out of control in the big cities.”
Untreated, gonorrhea, a highly contagious infection of the urethra and genital tract, can lead to permanent health problems—including pelvic inflammatory disease and sterility in women, and genital infections in men. In any form, the disease can cause internal damage within two weeks of infection. But with the spread of PPNG, which has to be treated with costlier alternatives to penicillin such as spectinomycin, health officials face a dilemma: until laboratory tests are conducted to determine
the strain of gonorrhea, doctors can only guess at whether a routine course of penicillin will help. By the time that the tests are complete, a patient may have suffered irreversible damage.
PPNG originated in Southeast Asia and Africa, and some experts think it could have been introduced into North America by infected soldiers returning from the Vietnam War. Health officials say that they are concerned that the new strain will spread in North America as fast as it has in such cities as Singapore and Ho Chi Minh—where PPNG is now estimated to account for 40 per cent of all cases of gonorrhea. As a result, doctors in some areas of the United States have started to treat all cases of gonorrhea as if they were penicillin-resistant. And last year officials at the Atlanta-based Centers for Disease Control announced that anyone who had contracted gonorrhea after travelling to Florida, New York City or Los Angeles should be treated for PPNG.
The new gonorrhea strain poses a special threat to young women. The decreased incidence of gonorrhea is not yet evident among women between 15 and 19. In Ontario alone, during a four-week period in June six women were diagnosed as having PPNG—five of whom were under 20. “That tells it all,” said Dr. Kathleen Givan, director of laboratories at Toronto’s Women’s College Hospital. And she added that a female patient may not immediately be aware that the treatment is not working. Said Givan: “She would not have much in the way of symptoms in the first place, and she could suffer serious damage in two weeks.”
Givan and Dillon say that finding a method of accurate diagnosis has become a critical necessity. Dillon says that doctors will have to learn how to diagnose and treat the new strain of gonorrhea. And with the higher price tag of penicillin alternatives—spectinomycin costs about $10 a dose compared to about $1 for penicillin—PPNG is likely to prove costly. But that extra cost may prove to be necessary to curb the spread of a debilitating disease.
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