With Resistance to Treatment Rising, CDC Updates Gonorrhea Treatment Guidelines

From The National Coalition Of STD Directors:

Today, the Centers for Disease Control and Prevention (CDC) released updated guidelines for the treatment of the sexually transmitted disease gonorrhea, which is a major cause of pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate HIV transmission.[i]  CDC estimates there are more than 700,000 gonorrhea infections each year in the United States.  The updated guidelines were published in CDC’s Morbidity and Mortality Weekly Report. 

The change marks an end to CDC exclusively recommending oral antibiotic treatment as the first line of defense for gonorrhea, and now instead recommends that infections be treated with the injectable antibiotic ceftriaxone in combination with one of two other oral antibiotics, either doxycycline or azithromycin.  This change in treatment has significant implications for clinical service delivery and infected patients alike, as the simple act of taking pills is replaced by an administered injection by a certified health professional.

“We applaud the CDC’s preemptive strike of changing recommended treatment and with the intention of extending the life of the last effective drug,” said William Smith, Executive Director of the National Coalition of STD Directors (NCSD). “However, the rising resistance of gonorrhea to our last line of defense against it must be a clarion call to policymakers and private industry alike to invest in the research and development pipeline for new antibiotics and more sophisticated diagnostics…and quickly.  We desperately need additional options to meet the challenges of this infection,” continued Smith.

Last summer, the CDC sounded the alarm on gonorrhea’s rising resistance to antimicrobials. This report outlined that we are on the verge of a highly untreatable gonorrhea epidemic as   gonorrhea has developed resistance to every class of antibiotics put up against it and there is no new drug in the pipeline.  Documented increases in resistance throughout the U.S. are what has prompted the CDC to make the current recommended treatment change.

Full presser here.

Gay Men Are Flunking The Test

Also published on Bilerico.com

Yesterday, I posted an article about  a press release by the Journal Of The American Medical Association:

“…all adult patients, regardless of CD4 cell count, should be offered antiretroviral therapy (ART), according to an article in the July 25 issue of JAMA, a theme issue on HIV/AIDS. Other new recommendations include changes in therapeutic options and modifications in the timing and choice of ART for patients with an opportunistic illness such as tuberculosis.”

This follows the “treatment as prevention” model, based on the scientific research that people with HIV on antiretroviral therapy- with an undetectable viral load- are 96% less likely to pass on the virus.
us-statistics-2.jpgThis seems to be very good news. If you have HIV, you should find out early, get on meds and you’ll have a better chance of living a longer healthier life.

So what’s the problem? The problem is twofold:

  1. People at risk aren’t being tested: 20-25% of all HIV-infected people don’t know they have it.
  2. People at risk are still not being tested: Gay and Bisexual men of all races are the most severely affected by HIV

That’s not a typo- they’re basically the same reason, but there’s a difference. Any guesses?

Hint: It’s probably why most gay men won’t even read this article.

20-25% of all people with HIV don’t know they have it. Why not?

Here’s my take: Denial is one of the strongest mechanisms in the human psyche. It is fed by lack of information, by avoidance and by a strong desire for an alternative reality. If you’ve had unprotected sex, you’ve probably engaged in the process of denial. You’ve probably downplayed the risk, probably lied to yourself a little. You may have even gone over and over it in your mind, seizing every opportunity to deny the possibility of trouble.

“He looked okay”; “He didn’t seem sick”; “He pulled out”; “He would have told me if he had HIV”, etc, etc, and etc.

Well, we all know where that goes…. As individuals, we’re not facing facts. If we were, we’d be getting tested.

us-statistics-1.jpgGay and Bi men of all races are the most severely affected by HIV. Of course. We know that. Don’t we?

Again, denial applies. Gay and Bi men aren’t talking about HIV anymore. Our friends aren’t dying, so there’s no reason to be concerned. People with HIV aren’t out- aren’t well-known in our communities. Why? I was once told “You don’t need to harp about HIV all the time- it’s not that big of a deal.” Except that it is.

HIV has complicated my life in ways many people can’t believe. I am on catastrophic health insurance through the state- almost three times as expensive as my partner’s insurance. I get assistance for my meds- which cost about $25,000 a year- but (crazily), I can’t make more than $30,300 and still qualify for the program. I have joint pain, sleep issues, battles with depression, fatigue and a body that is aging at several times the normal rate- most probably due to inflammation- the hallmark of HIV disease. And yet, if I talk about this to friends or family, I’m seen as a whiner or someone trying unnecessarily to worry people I care about. It’s the “shut up- at least you’re not dying” defense. I know several HIV+ people who haven’t told anyone of their status, mostly because it’s “uncomfortable”.

No shit.

As a community, we’re not facing facts. If we were, we’d be talking to our friends about the importance of maintaining our health. We’d be talking about the hard reality of HIV.

But we’re not. Denial still holds sway, both individually and as a community. We’re lying to ourselves- we’re lying to each other- and infection rates stay the same.

We have a chance to change this trend. But only if everyone with HIV starts treatment, gets into care. This recommendation of the AMA may help with that. But it’s not up to doctors, nurses and social workers, it’s up to us.

We’re being tested, both as individuals and as a community. The problem is, we’re flunking.

Because we’re not showing up.

(Images source)

Paying For Negative HIV Tests

Michael J. Coren writes a fascinating article about HIV: if health isn’t a good enough reason to protect yourself from HIV and STD’s, maybe money is.

Excerpt:

Scientists at MIT’s Poverty Lab recently published findings in BMJ Open that tested that theory in Tanzania. They used payments known as conditional cash transfers (CCTs)–known to encourage socially desirable behavior elsewhere in areas like such as school enrollment and medical check-ups–to deter risky sex among young people (18 to 30-year-olds) in Tanzania.

As much as 5% of Tanzania’s population is infected with HIV/AIDS. Although rates have declined there during the last five years, the country’s sub-Saharan neighbors are not so lucky. Just 10 sub-Saharan countries account for more than one-third of people infected with HIV worldwide; an equal proportion of new cases also occur there. It’s clear controlling existing infections is not enough; cheap and effective prevention is needed.

The MIT researchers asked about 2,000 participants to receive tests for four common STIs–chlamydia, gonorrhea, trichomonas, and M. genitalium–every four months during the course of a year. If results were negative, participants were paid $10, $20, or nothing depending on the experimental group. If positive, participants were treated, but did not receive cash. The STIs served as a proxy for HIV infection risk from sex, since payments were not contingent on HIV status, given the stigma attached to the infection in many communities.

Read the results here.

Missoula County Sees Spike In HIV Infection

HIV infection has increased unexpectedly in Missoula County- 12 new cases in five months- almost half the number of all reported cases in Montana last year.

From The Missoulian:

“We tend to see small numbers of new cases every year, but to have this many new cases – at this count 12 – documented in a five-month period is an unusually high number,” Missoula City-County Health Department Director Ellen Leahy said on Wednesday. “Twelve cases in one county in five months is an outbreak.”

HIV causes acquired immune deficiency syndrome or AIDS, a debilitating and sometimes fatal disease. It is spread by unprotected sexual contact or infected blood transfer, such as sharing infected hypodermic needles. Leahy said all the Missoula cases appeared to stem from sexual activity.

The announcement was made after consulting with many community groups, including Partnership Health Center, the Montana Gay Men’s Task Force and the Open Aid Alliance. Open Aid director Christa Weathers said the decision to publicize the outbreak was a hard one, because health officials depend on people self-reporting their condition to track the disease’s spread.

“It’s hard to issue a public health risk without creating alarm, or without pointing fingers at any group of people,” Weathers said. “It’s a great opportunity to remind people this is a risk and why testing is so important. But we don’t want to discourage anyone who may know they may need to get tested, but they’re afraid to come in and then this hits the media and they’re gone.”

So far, all the confirmed cases are adult males. But Leahy warned that women who don’t consider themselves members of a high-risk group for HIV infection have also been exposed.

“It’s sexually spread, but it’s time to remind ourselves – you really cannot know if you’re infected unless you’ve been tested,” Leahy said. “We recommend health clinics regularly offer HIV testing to sexually active patients. Rather than presume someone is in a risk group, it’s risk behavior, not membership in any group, that they need to think about.”

Several of my sources say the newly-infected persons are young men who simply didn’t practice safe sex, thinking “It’s Montana- I’m not at risk”. These men, mostly in their twenties, I’m told, will now have a lifetime of medication, stigma and health issues to deal with. It saddens me.

Today is a good day to be tested. For a list of Montana free Rapid HIV Testing sites, click here.

If you’re in Bozeman, call AIDS Outreach 406-451-5718 (the number in the link above is incorrect) or go to AIDSOutreachMT.org

New Drug Targets Viral Infections- Hope for HIV?

Science Daily reports a dramatic breakthrough in drug treatment of viral infection:

Influenza Virus

Most bacterial infections can be treated with antibiotics such as penicillin, discovered decades ago. However, such drugs are useless against viral infections, including influenza, the common cold, and deadly hemorrhagic fevers such as Ebola.

Now, in a development that could transform how viral infections are treated, a team of researchers at MIT’s Lincoln Laboratory has designed a drug that can identify cells that have been infected by any type of virus, then kill those cells to terminate the infection.

Viruses are notoriously difficult to treat- technically, they aren’t “alive” so there’s not an effectively good way to “kill” them. Killing the specific cells in which they reside seems like a good place to start- and also has implications for the treatment of cancer, HIV- any disease which starts with an infected or mutated cell.

Read the full article here.

Thought You Didn’t Have To Worry About Hepatitis C?

Hot on the heels of Godzilla Gonorrhea, comes further buzzkill from Science Daily:

Sexual transmission of hepatitis C virus (HCV) is considered rare. But a new study by researchers at Mount Sinai School of Medicine, working with the Centers for Disease Control and Prevention (CDC), provides substantial evidence that men with HIV who have sex with other men (MSM) are at increased risk for contracting HCV through sex.

Yeah. I know- what next? And while it bears further watching, it’s still not the end of the world:

“While hepatitis C is rarely transmitted among stable heterosexual couples, this is clearly not the case among HIV-infected MSM in New York City,” said Dr. Daniel Fierer, Assistant Professor of Medicine and Infectious Diseases at Mount Sinai School of Medicine. “MSM, and to some extent their health care providers are generally not aware that having unprotected receptive sex can result in HCV infection. The good news is that the cure rate for new HCV infections is very high with early treatment, but without regular testing of the men at risk, these largely asymptomatic infections may be missed and this opportunity lost.”
“Our study suggests that HIV-infected MSM should take steps to protect themselves and others by using condoms. Also, health care providers should be screening these men for hepatitis C, and public education and outreach programs should include information about these risks,” Dr. Fierer concluded.

And if you think you’re at risk, (for more info, click this link) you should talk to your healthcare provider and/or ask to be tested.

Your health is YOUR health. Advocate for it.