Antimicrobial-resistant Gonorrhea

Gonorrhea is the second most commonly reported notifiable disease in the United States. National concerns about increasing rates of gonorrhea and increasing antimicrobial resistant strains of N. gonorrhoeae are prompting increased efforts to ensure adherence to the revised 2015 Sexually Transmitted Disease Treatment Guidelines.

U.S. CDC now recommends treating gonorrhea with ceftriaxone 250 mg as a single intramuscular dose and azithromycin 1 g orally.

Clinicians need to use dual therapy and stay up to date with treatment recommendations: 

• Data show that resistance decreases when the correct dual therapy is used.
• Using azithromycin as a monotherapy to treat gonorrhea might promote the emergence of azithromycin resistance.
• Patients with cephalosporin allergies should be treated with azithromycin 2 g plus either gentamicin or gemifloxacin.

There has been a steady increase in the number of reported gonorrhea cases in Maine. As of June 30, 2016, 251 cases of gonorrhea have been reported to the Maine CDC. The five-year median for this time period is 116 cases. The increase in gonorrhea in Maine mirrors a national trend reported by U.S. CDC. 

Gonorrhea

US CDC has issued an MMWR describing the growing threat of multidrug-resistant gonorrhea and what public health agencies and partners can do to delay the emergence of cephalosporin-resistant strains, mitigate the public health consequences of expanded resistance, and prevent a return to the era of untreatable gonorrhea. For these strategies and more information, see the MMWR at: http://go.usa.gov/4JY3


A total of 40 confirmed gonorrhea cases have been reported in Maine through Feb. 16, compared to 54 reported cases in 2012 and 19 reported cases in 2011 during the same period. Some cases are reported more than once and may represent reinfection, recurrent infection, or persistent infection.

The majority of cases have been reported in Androscoggin County, followed by Cumberland County. Maine CDC is issuing biweekly gonorrhea surveillance updates. The most recent report is available at: http://go.usa.gov/4JrF

Current treatment guidelines and reporting requirements are included in this Health Alert from Dec. 4: http://go.usa.gov/4JY9

Maine CDC Public Health Update 12/13/12

Pertussis (whooping cough)

Thirty cases of pertussis (whooping cough) have been reported in children younger than 1 year old in Maine so far this year. Maine CDC has issued new clinical guidance for providers treating infant pertussis. It is available on the Maine CDC website.

In total, more than 660 cases of pertussis have been reported in Maine this year, with the majority in children ages 7 to 19. Reported cases appear to be on a downward trend.

Weekly updates on pertussis in Maine are posted to www.mainepublichealth.gov on Thursdays.

DTaP vaccine is recommended for all infants and children. Tdap vaccine is recommended for all preteens, teens, and adults.

For more information, visit http://go.usa.gov/dCO


Recent health alerts

• Group A Strep: Maine CDC is investigating a cluster of invasive Group A Streptococcal (GAS) infections in patients who have reported a history of injecting bath salts. Four cases of invasive GAS have been reported among persons aged 23-37 years, two of which resulted in Streptococcal Toxic Shock Syndrome (STSS). All cases reported injecting bath salts, all required hospitalization, one required intensive care, and one had necrotizing fasciitis. All four cases are from Aroostook and Penobscot counties. The health alert is at: http://go.usa.gov/gPfj

• Gonorrhea: Gonorrhea is a sexually transmitted disease caused by the Neisseria gonorrhoeae bacterium. Gonococcal infection is reportable to Maine CDC within 48 hours of recognition or strong suspicion of disease. In men, common symptoms include burning sensation when urinating or a white, yellow or green penile discharge. In women, symptoms are uncommon, but may include painful or burning sensation when urinating or increased vaginal discharge. Gonorrhea is a major cause of serious reproductive complications in females. Case reports of gonorrhea in Maine have been increasing in recent years from 96 cases in 2008 to 272 cases in 2011. The health alert is available at: http://go.usa.gov/gPf5

Influenza

Maine CDC reported regional flu activity for the week ending Dec. 8. Weekly updates are available online:

• for Maine: http://go.usa.gov/NoK
• for the US: http://go.usa.gov/ITB
• for the world: http://go.usa.gov/ITK

Maine CDC reminds everyone to take everyday preventive measures against the flu: 

• Wash your hands frequently
• Cough and sneeze into your elbow or shoulder
• Stay home when you feel sick
• Get vaccinated – find locations at www.flu.gov

America's Health Rankings

Maine ranked ninth overall (up from tenth last year) in the recently released America’s Health Rankings by the United Health Foundation.

These rankings are used to stimulate action by individuals, elected officials, medical professionals, public health professionals, employers, educators and communities to improve the health of the population of the U.S.

For more information, visit http://www.americashealthrankings.org/ME


HIV and hepatitis screenings

Recently, the U.S. Preventive Services Task Force (USPSTF) issued draft recommendations pertaining to HIV and viral hepatitis screening and is inviting public comments on both.


The Task Force is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.

The draft recommendation for HIV screening applies to all people aged 15 to 65 and all pregnant women. Public comments can be submitted online until December 17.

Public comments on the draft recommendations for screening adults for hepatitis C virus infection can be submitted online until December 24.

For more information and to submit comments, go to http://www.uspreventiveservicestaskforce.org/index.html

HIV/STD Updates

 The US Department of Health and Human Services (HHS) has released updated HIV treatment recommendations: http://go.usa.gov/yTI

The updated recommendations have changed significantly regarding when to initiate antiretroviral therapy (ART).  Antiretroviral treatment is now recommended for all HIV infected individuals.  The strength of these recommendations depends on an individual’s CD4 count, but if an individual is at risk of transmitting HIV to HIV-negative sexual partner(s) the strength of the recommendations increases. 

Several HIV/STD surveillance documents have recently been added to Maine CDC’s website:

• March Monthly Update for HIV and STDs: http://go.usa.gov/yTR
• 2010 Annual HIV/STD Surveillance Report: http://go.usa.gov/yTQ
• A detailed report on HIV for 2011: http://go.usa.gov/yTE
• A detailed report on chlamydia and gonorrhea for 2011: http://go.usa.gov/yTV

US CDC Director Dr. Tom Frieden will host a live Twitter chat on STDs and young people at 1 p.m. April 23. Follow the conversation by using hashtag #CDCChat. Follow Dr. Frieden on Twitter:  http://twitter.com/DrFriedenCDC