A form of gonorrhea that is highly resistant to standard antibiotics is rampant in San Diego, especially among men who have sex with men (MSM), and is rising across the country, federal officials announced last week. Consequently, the Center for Disease Control (CDC), which, in 2004, recommended a new class of drugs to treat the disease in MSMs, is advising extending the treatment to all gonorrhea patients.

“This story is not so surprising in California because we’ve known about this resistance issue for years,” said Dr. Robert Gunn, sexually transmitted disease control officer for the county’s Health and Human Services Agency. “Now that the number has increased across the nation, bringing the national average above 5 percent, the CDC has updated the protocol for everyone.”

Fluoroquinolones, a class of antibiotics that includes Cipro, have been used to treat gonorrhea since the early ’90s. However, because gonorrhea has grown increasingly resistant to fluoroquinolones, the CDC now recommends using cephalosporins, a class of antibiotics that includes Rocephin, to treat the bacterial disease.

According to Terry Cunningham, chief of San Diego County’s Health and Human Services Agency, HIV, STD and Hepatitis Branch, in 2001, the percentage of fluoroquinolone-resistant cases was only 0.6 among heterosexual men.

“That number increased nearly 11 times and jumped to almost 7 percent in just five years,” Cunningham said, adding that last year a survey of 26 U.S. cities found that nearly 7 percent of gonorrhea cases among heterosexual men were drug resistant.

Gonorrhea is the second most reported infectious disease in the U.S., and in San Diego 25 percent of all gonorrhea cases among heterosexual men are fluoroquinolone-resistant. That is four times the national average.

“Not everybody that has gonorrhea has the resistant strain, but we have learned that it is even more prevalent among the gay community,” Cunningham said.

In 2001, the rate of fluoroquinolone-resistant cases was 1.6 percent for men who have sex with men (MSM). That number increased to 38.6 percent in 2006.

CDC officials, observing the increasing trend among MSMs, made the change in treatment protocol to cephalosporins strictly for MSM in 2004.

The CDC has found some of the highest levels of drug-resistant gonorrhea not only in San Diego but also in other West Coast port cities. Local officials speculate this dramatic rise is because many of the places where cases have been documented are attractive for tourists.

“I don’t want to blame anybody, but new strains of gonorrhea often arise in East Asian countries and are taken to West Coast regions like San Diego through travelers and the military,” Gunn said. He added that San Francisco and Long Beach, two other port cities, also lead the list. Orange County and Honolulu also have extremely high rates of the disease.

“San Diego is a Navy town, and we also have people who work in Mexico who come from Asia and enter the country. Clearly San Diego is an international entry point,” Gunn said.

According to both Cunningham and Gunn, local health officials anticipated the new recommendations from the CDC and made sure the county is prepared with cephalosporins to treat resistant cases.

“The problem we have with this organism is like any other bacteria, they want to survive so they develop resistance to certain antibiotics, but there haven’t been any problems of resistance found when it is treated with the new drugs,” Gunn said. He noted the only problem may be some discomfort for those who are afraid of needles because the new drug is administered by injection.

“People who are sexually active and not protecting themselves need to get screened on a frequent basis to make sure they’re not infected with gonorrhea or chlamydia,” Gunn said.

According to the CDC, when used properly, condoms are “highly effective” against the transfer of gonorrhea or other STDs. Because the infectious material is found in the vaginal mucous and penile ejaculate, an intact latex condom worn prior to intimate contact is very effective against transmission.