{"id":1250,"date":"2017-01-31T16:11:18","date_gmt":"2017-01-31T16:11:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1250"},"modified":"2017-01-31T16:11:18","modified_gmt":"2017-01-31T16:11:18","slug":"a-new-kind-of-treatment-for-multi-resistant-gonorrhoea","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/31\/a-new-kind-of-treatment-for-multi-resistant-gonorrhoea\/","title":{"rendered":"A new kind of treatment for multi-resistant gonorrhoea?"},"content":{"rendered":"<p>Recent research at York University (<a href=\"http:\/\/pubs.rsc.org\/en\/content\/articlelanding\/2017\/md\/c6md00603e#!divAbstract\">Ward &amp; Lynam<\/a> (W&amp;L)), UK, suggests the possible efficacity of carbon monoxide-releasing molecules as an antimicrobial against gonorrhoea.\u00a0 The work is at an early stage \u2013 but the urgency of our current situation lends it a heightened interest.<\/p>\n<p>Growing\u00a0 resistance of <em>Neisseria gonorrhoeae<\/em> (Ng) to the last-defence antibiotic treatments (<a href=\"http:\/\/sti.bmj.com\/content\/91\/4\/234.abstract?sid=a83285a3-4e39-4f97-abc0-8db71e3da1f9\">Lewis\/STIs<\/a>) \u2013 cephixime and ceftriaxone \u2013 has placed sexual health policy in a dilemma: to have an impact on the epidemic requires them to\u00a0 focus treatment on core-groups; yet the treatment of these individuals has to be shown to heighten antibiotic resistance (<a href=\"http:\/\/sti.bmj.com\/content\/88\/3\/200.abstract?sid=39a7bccc-b521-4eda-b61c-fbf9746fdb90\">Chan &amp; Fisman\/STIs<\/a>).\u00a0\u00a0 <a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_4\/iv52.abstract?sid=be95327c-0452-4612-85d3-4e7a5fe77f16\">Ison &amp; Unemo\/STIs<\/a> survey the narrowing options, including heightened surveillance (see also <a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_4\/iv42.abstract?sid=39a7bccc-b521-4eda-b61c-fbf9746fdb90\">Unemo &amp; Khotenashvili\/STIs<\/a>) and the careful stewarding of our remaining antibiotic resources.\u00a0 Others suggest recourse to less obvious measures, such as the comprehensive treatment of pharyngeal Ng in MSM (<a href=\"http:\/\/sti.bmj.com\/content\/91\/4\/234.abstract?sid=a83285a3-4e39-4f97-abc0-8db71e3da1f9\">Lewis\/STIs<\/a>), or the use of topical antiseptics (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/12\/30\/sextrans-2016-053028.extract?sid=80070f8e-e8af-4e5a-9981-56974c04f756\">Miari &amp; Ison\/STIs<\/a>).\u00a0 Ultimately, however, the answer will lie in the developments of new antibiotics.<\/p>\n<p>So how about the York researchers\u2019 carbon monoxide-releasing molecules (CORMs)?\u00a0 Though \u2013 to repeat \u2013 it is early days, this avenue looks promising.\u00a0 The agent, tryptophan manganese carbonyl (Trypto-CORM), has been shown by earlier studies to be toxic to <em>Escherichia coli<\/em> and <em>Staphylococcus aureus<\/em> through the effect of CO molecules released by Trypto-CORM when irradiated.\u00a0 W&amp;L report that in the case of Ng, the bacterium appeared to be destroyed even by the very small amounts of CO released <em>before<\/em> irradiation.\u00a0 The idea that Ng might be \u2018exquisitely sensitive\u2019 to CO would, of course, be good news. \u00a0It suggests the levels of CO necessary for efficacity against Ng might be sufficiently low to eliminate undesired toxic effects.\u00a0 However, the results of W&amp;L \u00a0also raise the suspicion that in the case of Ng, the cytotoxic effect might arise from some mechanism other than release of CO.\u00a0 Fortunately, another innovation of the study appears to eliminate that possibility.\u00a0 This is the use of extremely high CO affinity leg-haemoglobin (as opposed to the less high affinity deoxy-myoglobin) to \u2018rescue\u2019 the Ng culture by \u2018scavenging\u2019 the CO.\u00a0 So it really does seem that the sensitivity of Ng to CO, not some other mechanism, is producing the cytotoxic effect.<\/p>\n<p>A final potentially medically significant element of the study is the effect of culture age.\u00a0 Cultures that had been stored for are longer time were more sensitive to Trypto-CORM \u2013 a finding that turns out not to be attributable to the number of viable cells in the inoculums.\u00a0 The authors suggest the effect is due to the depletion in the number of active haem-copper oxidase complexes in near dormant cells.\u00a0 This too could be good news.\u00a0 Persistent bacteria in an infection that are recalcitrant to treatment are frequently slow-growing or dormant, and could be particularly susceptible to Trypto-CORM.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Recent research at York University (Ward &amp; Lynam (W&amp;L)), UK, suggests the possible efficacity of carbon monoxide-releasing molecules as an antimicrobial against gonorrhoea.\u00a0 The work is at an early stage \u2013 but the urgency of our current situation lends it a heightened interest. Growing\u00a0 resistance of Neisseria gonorrhoeae (Ng) to the last-defence antibiotic treatments (Lewis\/STIs) [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/31\/a-new-kind-of-treatment-for-multi-resistant-gonorrhoea\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4353,2788,2103],"tags":[],"class_list":["post-1250","post","type-post","status-publish","format-standard","hentry","category-antimicrobial-resistance","category-antimicrobials","category-gonorrhoea"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>A new kind of treatment for multi-resistant gonorrhoea? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/31\/a-new-kind-of-treatment-for-multi-resistant-gonorrhoea\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A new kind of treatment for multi-resistant gonorrhoea? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Recent research at York University (Ward &amp; Lynam (W&amp;L)), UK, suggests the possible efficacity of carbon monoxide-releasing molecules as an antimicrobial against gonorrhoea.\u00a0 The work is at an early stage \u2013 but the urgency of our current situation lends it a heightened interest. 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