Ask the Doc: Bacteria Is the Enemy in Two New Infections

You would think that HIV and hepatitis were enough to worry about! Unfortunately, there's more. Two related bacteria -- Neisseria meningitides and Gonorrhea -- are up to no good in the gay community. In this installment of Ask the Doc, we will discuss the recent outbreak of meningitis in men who have sex with men in New York City, as well as the impending threat of nearly untreatable gonorrhea.

Q: What is the meningococcal outbreak in gay men about? Do I need a vaccine?

A: There is currently an outbreak of meningococcal disease in New York City among men who have sex with men (MSM). Meningococcal disease is a serious bacterial infection caused by the organism Neisseria meningitidis. It mainly causes meningitis, an inflammation of the membranes of the brain and spinal cord, and blood poisoning. Common symptoms include fever, weakness, headache, neck stiffness and rash.

Meningococcal disease is a severe illness and may lead to death in many cases if not caught early enough. The good news is that we have a vaccine to prevent it! Meningococcal disease is often associated with communal living, which is why vaccine is recommended for people moving into a college dormitory. Cases often make the news when an outbreak happens on a college campus and may require many people to take antibiotics to prevent infection after an exposure.

Meningococcal disease is spread by close contact. Close contact occurs in people who live together and also includes kissing, coughing, cuddling, or sneezing. Sharing eating utensils, glasses, food or towels can also spread this bacterium. Some people exposed to the bacterium will develop infection, while others might just carry it in their throats with no symptoms. These asymptomatic individuals might still spread the bacterium without even knowing it.

The first report of this outbreak among MSM in NYC came out of the NYC Department of Health and Mental Hygiene (DOHMH) in October 2012, at which point recommendations were made that all MSM with HIV and HIV-negative men who engage in "high-risk sexual behaviors" with another man by meeting them on a website, telephone application, at a bar, or in a club. Since then more cases have been identified throughout the city, with some of them being fatal. This has prompted authorities at the DOHMH to expand their recommendations as follows:

� All HIV-infected men who have sex with men (should get two doses 8 weeks apart)
� All HIV-negative men who have sex with men who have close or intimate contact (NOT JUST SEX...That includes making out/cuddling) with men they met online, on an app, or at a bar or party. (One dose is adequate)

To find out if you need the vaccine and how to get it in NYC speak to your healthcare provider or visit www.nyc.gov/html/doh/html/diseases/cdmen.shtml or www.gmhc.org

Q: Is it true that gonorrhea is becoming resistant to the antibiotics used to treat it? What happens next? How can I protect myself?

A: Sad but true, the bacterium that causes Gonorrhea called Neisseria gonorrhea (yes, that's right...it's related to the meningitis bug) is becoming more resistant to the antibiotics we use to treat it. Gonorrhea commonly causes infections of the penis, the throat and anus in men who have sex with men. Symptoms depend on where the infection is. Throat infections feel like strep throat, although some men with no symptoms might have the bacteria in the back of their throats, just like the meningitis bug I discussed in the last question.

If the infection is in the penis it can be associated with pain with urination or a "drip" or discharge. Anal infections are associated with pus and blood from the anus as well as pain with sex or passing stool. Even the infections in the penis and anus might be associated with no symptoms, so someone might not even know they have gonorrhea and could spread it.

Gonorrhea has become more and more resistant. It has never met an antibiotic it couldn't outrun. In the '70s and '80s, it became resistant to penicillin. In the '90s-'00s, it became resistant to a class of drugs called fluoroquinolones. Now we are facing resistance to a class of drugs called cephalosporins, a relative of penicillin that has been the stand-by for gonorrhea infections for many years.

First we lost the ability to use cefixime, an oral antibiotic. Now ceftriaxone, an injection that was an anti-Gonorrhea workhorse is threatened with levels of resistance rising in strains of Gonorrhea being tested in the United States. That means that we have to use dual therapy and some less appealing drugs to treat the infection.

The current recommendations are that Gonorrhea be treated with a ceftriaxone injection PLUS a one time dose of oral azithromycin. Symptoms after treatment should be gone within seven days. Anything beyond that might mean that the bacterium causing the symptoms might be resistant and testing is needed to figure out what the next drug we can use is. Testing for a cure is also important if you are treated with any regimen other than the ceftriaxone/azithromycin combination. Studies are going on now to figure out what the future for treatment holds if Gonorrhea continues to become more and more of a resistant super-bug.

Protecting yourself and others against drug-resistant Gonorrhea comes down to using condoms for anal and vaginal sex and being aware that Gonorrhea may be transmitted via oral sex as well. It is important to get tested for this and other sexually transmitted infections often. Depending on your level of risk, you should get tested once every 3-12 months.

See your doctor or visit http://www.cdc.gov/std/Gonorrhea/ to learn more. Protecting yourself means protecting our community from the spread of this infection.