Sexually Transmitted Infections – “So you want to be tested for everything…”

shutterstock_36483805I frequently have patients come into the office and ask for STI (sexually transmitted infections) screening.  This is often done when they start a new relationship, when they find out that a partner has been unfaithful or if they have unprotected sex with someone that they don’t know well.  Patients often have no understanding of which sexually transmitted infections (formerly referred to as sexually transmitted diseases) they should be checked for and rely on their health care providers to order the proper tests and discuss the results with them.  Patient’s often will refer to being “clean” or “clear” when referring to their screening results.  When I ask them which infections they would like to be screened for, I usually hear something like “check me for everything.”

I think it’s important for patients to know which infections are most common, what the symptoms might be and know what to ask for when going to your doctor to be checked for sexually transmitted infections.  It’s also important to understand that some infections can be cured (with antibiotics), some infections can be controlled but never eradicated completely, and some infections can be present and not have any symptoms for years before becoming apparent.  Checking for “everything” might mean different things to different patients or medical providers, so my advice is to be very specific with what tests you request your medical provider order and keep track of the results so that when you think about “being clean” or “clear” of infection, you know exactly which infections you are clear of.

Types of infections:

1)  Chlamydia:  The most common sexually transmitted infection in the U.S.  This infection can cause pain and inflammation of the urethra (opening where urine comes out), the testicular area, the cervix and anus.  If untreated chlamydia can lead to infertility, chronic pelvic pain, prostatitis, and even severe infections of the fallopian tubes or tubal pregnancy.  Most men and women who are infected with chlamydia do not have symptoms.  Testing can be done with a urine sample from the patient or a swab.

2)  Herpes simplex virus:  It is estimated that about ¼ of the US population has herpes type 1 or 2 and many infected patients are unaware that they have the virus.  Skin ulcers are a result of the infection and increase the risk spreading or acquiring HIV.  Many patients with herpes are not screened because unless patient’s give a description of an ulcer in the genital area, a blood test for the antibodies to the viruses is usually not ordered.  If an ulcer is present, a swab may be collected by touching an open ulceration and sent for viral culture.  If you are concerned that you may have genital herpes, make sure you tell your medical provider and discuss testing with them because routine testing for herpes is usually not done unless there is some suspicion of infection.

3)  Gonorrhea:  The highest rates of infection are in sexually active 15-19yo women and 20-24yo men.  Rates are 20x higher in African-Americans than in whites.  Infection can lead to pain and inflammation of the urethra (opening where the urine comes out), sore throat and anal infection.  If untreated it can lead to serious complications in women including pelvic inflammatory disease and infertility.  Testing is frequently done from a urine sample or a swab.  Because of high rates of reinfection, patients diagnosed with gonorrhea should be advised to retest in 3 months.

4)  Trichomoniasis:  Infection with trichomonas produces symptoms similar to a urinary tract infection including pain and inflammation of the urethra (where the urine comes out), and/or vaginal discharge.  It can be present and men or women.  Most men who are infected do not have symptoms.  Testing is done by examination of a urine specimen.  Testing for trichomonas is not generally done on routine screening for STDs unless the patient asks for it or has symptoms.

5)  Syphilis:  Testing for syphilis is done with a standard blood test normally.  Symptoms of syphilis vary depending on the stage of infection.  Initially there is the appearance of a single sore mark, but there may be multiple sores.  The sore is usually firm, round and painless.  Because the sore is painless, it can easily go unnoticed.  It lasts 3-6 weeks and heals regardless of whether or not the person is treated.  If the infected person does not get treatment, the infection will progress to the second stage.  Skin rashes and/or sores in the mouth, vagina and anus (also called mucous membrane lesions) are typical of the second stage of symptoms.  The rash usually does not cause itching and may appear as rough, red or reddish brown spots both on the palms of the hands and/or the bottoms of the feet.  Sometimes rashes associated with secondary syphilis are so faint that they are not noticed.  Other symptoms of secondary syphilis include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.  The symptoms of secondary syphilis will go away with or without treatment.  Without appropriate treatment, the infection will progress to the latent and possibly late stages of disease.  The latent (hidden) stage can last for years.  About 15% of people who have not been treated for syphilis develop the late stage of the disease.  This stage can occur 10-30 years after the infection began and symptoms can include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia.  Damage to the internal organs, including the brain, nerves, eyes, heart, liver, bone and joints can occur and result in death.

6)  Hepatitis A, B and C:  Hepatitis that is transmitted by sexual contact is caused one of several different viruses (A, B or C).  All types of hepatitis virus infections can cause liver inflammation.  Hepatitis B and C can cause severe infection and lead to liver failure and death.  Hepatitis A is more commonly a cause of food-borne outbreaks.  Because there are vaccinations available for hepatitis A and B, we are seeing more patients recently developing hepatitis C because we currently do not have a protective immunization.  Hepatitis testing can be done through a simple blood test similar to HIV testing.  The initial test for hepatitis is usually done by trying to detect the antibody to the virus.  It can take your body several months after being infected with the hepatitis virus to develop the antibody and therefore there is a period of time called the “window period” when the test result may be negative even though the infection is present.  A repeat test is usually offered 3-6 months after the initial negative test for confirmation that the patient is negative after “high risk sexual contact.”

7)  Human Immunodeficiency virus (HIV):  It is important to recognize that patients who have been infected with other sexually transmitted infections may also be infected with HIV.  Recent recommendations from the Centers for Disease Control (CDC) recommend opt-out screening and annual screening for those at high risk for HIV infection.  The test for HIV is an antibody test.  Similar to hepatitis, it can take your body several months after being infected with HIV to develop the antibodies, and therefore there is a period of time called the “window period” when the test result may be negative even though infection is present.  Repeat testing 3-6 months after a previously negative result after “high risk sexual contact” is recommended.  HIV causes suppression of your natural immune system and can lead to a constellation of problems associated with immune suppression (infections, cancer) and AIDS related syndrome.

8)  Human papillomavirus (HPV):  This virus is the main cause of cervical cancer.  There are routine screening guidelines that have been established for pap smears which are the main way of detecting this virus and treating it before the development of cervical cancer.  All sexually active women should have a screening pap test by age 21.  Women between the ages of 9 and 26 years old are recommended to receive the HPV vaccine to prevent cervical dysplasia and cervical cancer.  Routine vaccination is recommended for female between 11 and 12 years, but the vaccination series may be started as early as 9 years and females aged 13-26 years can benefit as well.  The quadrivalent HPV vaccine can also be used in males and females aged 9-26 years of age to prevent genital warts and anogenital cancers.

Recommendations for screening for sexually transmitted infections in pregnant women, men who have sex with men, women who have sex with women and HIV infected patients vary depending on the risk group.

State health department notification:  Medical providers are required to notify the local and state public health departments in the case of chancroid, chlamydia, gonorrhea, acute hepatitis b, acute hepatitis c, HIV and syphilis.

Partner notification:  In the event that a patient has been diagnosed with a sexually transmitted infection, partners should be notified, examined and treated.  In some cases, the patient directly provides their sexual contact with medications and prescriptions to be filled (Partner Delivered Patient Medication (PDPM) although this is not legal in all states.  Patients and their partners should not have sexual relations until seven days after a single dose treatment or upon completion of a seven day regimen in cases of bacterial infections.  Discussion with sexual partners can be difficult but is very important for the partner’s safety and to prevent re-infection of the patient who tested positive initially.

2010 treatment/screening guidelines as outlined by the Centers for Disease Control in 2010:

  1. All patients being evaluated for STIs should be offered counseling and testing for HIV.
  2. Hepatitis B screening should be offered to men who have sex with men (MSM), injection drug users (IDU), persons attending an STI clinic or seeking STI treatment, and persons with history of multiple sex partners.  Patients who are not immune should be offered vaccination.
  3. Hepatitis A screening should be offered to MSM and injection drug users.  Those who are not immune should be offered vaccination.
  4. Asymptomatic women with risk factors for STIs should be screened for gonorrhea and chlamydia infection each year.
  5. Males and female between the ages of 9 and 26 years old should be offered the human papillomavirus vaccination (HPV vaccination).
  6. The following screening tests for active MSM are recommended on at least an annual basis:  HIV, gonorrhea, chlamydia, and syphilis.
  7. Syphilis screening is recommended for commercial sex workers, persons who exchange sex for drugs and persons in correctional facilities.
  8. Pregnant women should be screened for gonorrhea, chlamydia, HIV, hepatitis B, and syphilis infections.
  9. HIV-infected patients should be screened annually for gonorrhea, chlamydia, syphilis, hepatitis B and hepatitis C.  Vaccination against hepatitis A and B is recommended for nonimmune patients.  HIV-infected patients who actively use injection drugs or intranasal cocaine, engage in unprotected sex, are men who have sex with men, or are undergoing dialysis should have ongoing screening for hepatitis C.
  10. Local and state public health departments should be kept informed of notifiable infections, which include chancroid, chlamydia, gonorrhea, acute hepatitis A and acute hepatitis B, acute hepatitis C, HIV and syphilis.
  11. Partners should be notified, examined, and treated for the STI identified in the index patient.  Patients and their sex partners should abstain from sexual intercourse until therapy is completed.

References:  http://www.cdc.gov/std/treatment/2010/default/htm

Centers for Disease Control and Prevention.  Sexually Transmitted Disease Surveillance, 2008. US Department of Health and Human Services, Atlanta, GA 2009

US Preventative Services Task Force. Screening for gonorrhea.  Agency for Healthcare Research and Quality, Rockville, MD. Revised January 2006.

US Preventative Services Task Force. Screening for syphilis.  Agency for Healthcare Research and Quality, Rockville, MD. Revised January 2006.

US Preventative Services Task Force. Screening for herpes.  Agency for Healthcare Research and Quality, Rockville, MD. Revised January 2005.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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What everyone should know about antibiotics and viral infections… Snort. Sniffle. Sneeze. No Antibiotics Please!

I have many patients who come into the clinic with a common cold and request antibiotics.  Antibiotics can be harmful to your body in many ways.  I think this is very important information from the CDC:

Are you aware that colds, flu, most sore throats, and bronchitis are caused by viruses? Did you know that antibiotics do not help fight viruses? It’s true. Plus, taking antibiotics when you have a virus may do more harm than good. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.  In addition, antibiotics can cause bloody diarrhea and abdominal pain that can last for weeks, severe life threatening allergic reactions (anaphylaxis) and rashes(hives).  Antibiotics can also damage some internal organs such as the liver or kidneys.   Improper antibiotic causes prolonged healing time and increased medical costs.

  • Antibiotics cure bacterial infections, not viral infections such as:
    • Colds or flu;
    • Most coughs and bronchitis;
    • Sore throats not caused by strep; or
    • Runny noses.
  • Taking antibiotics for viral infections, such as a cold, cough, the flu, or most bronchitis, will not:
    • Cure the infections;
    • Keep other individuals from catching the illness; or
    • Help you feel better.

When you use antibiotics appropriately, you do the best for your health, your family’s health, and the health of those around you. “We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics,” said Lauri Hicks, D.O., medical director of CDC’s Get Smart campaign.

What To Do

  • Talk with your healthcare provider about antibiotic resistance.
  • When you are prescribed an antibiotic,
    • Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect you.This goes for children, too. Make sure your children take all medication as prescribed, even if they feel better.Throw away any leftover medication once you have completed your prescription

What Not To Do

  • Antibiotics cure bacteria, not viruses such as:
    • Colds or flu;
    • Most coughs and bronchitis;
    • Sore throats not caused by strep; or
    • Runny noses.

Allergic Antibiotic Drug Reactions – Am I Truly Allergic to Penicillin?

shutterstock_124906745shutterstock_46021174I had a patient who came in recently with his parents because he broke out in a rash all over his body after starting an antibiotic for an infection in his throat.  The parents were obviously concerned that he was allergic to the antibiotic and wanted to know what to do to help him.

Allergies to medications, especially to antibiotics such as penicillin are common, but it’s sometimes confusing to know whether or not it’s a true drug allergy, a skin rash from the infection or perhaps not an allergy at all.  Yesterday a patient told me that they are allergic to penicillin, and when I asked them what happens he takes it he said that he’s unsure – he just knows he allergic because his father was. I was alarmed that he thought he had an allergy to a potentially life saving medication only because a family member had long ago told him that they had an allergy to penicillin.

About 10% of patients report an allergy to penicillin when asked, however most people who believe they are allergic can take penicillin without a problem either because they were never truly allergic or because there allergy to penicillin has resolved over time. Only about 20% of people will be allergic to penicillin 10 years after the initial allergic reaction if they are not exposed to it again during this time period.

Definition:  Penicillin is a common antibiotic that is prescribed for strep throat, ear infections as well as pneumonia and many other infections.  It is part of a family of medications called beta lactams which include: Penicllin G, amoxicillin, ampicillin, oxacillin, cloxacillin, dicloxacillin, piperacillin, and nafcillin.  A patient who is allergic to one of these penicillin medications is presumed to be allergic to any of them in this group.

The Reaction:  It’s very important to tell your medical provider in as much detail as possible what the reaction is that happens if you take the medication rather than just listing it as an allergy.  If your medical provider writes down that you are allergic to an antibiotic and it’s not a true allergy, this might mean that the next time they get an infection, you get a less effective or more toxic antibiotic.

It’s important to distinguish between a true allergy and “adverse reactions.” Adverse reactions are unexpected reactions that occur after taking a medication which are common but not true allergies.  Some patients report an adverse reaction as an allergy because they don’t want to be given this medication in the future.  For example, I had a patient tell me that they could not take prednisone because they are allergic.  When I asked what happens if he takes it, he replied – “I don’t like the taste.”   Unfortunately there are a limited number of medications, and they are most often grouped into families.  If you are truly allergic to one medication in the family, this eliminates the possibility of taking any other medication in the same family.  An entire group of potentially helpful medications might have been withheld from this patient only because he doesn’t like the taste of one of them in this group.  Another example of a non-allergic adverse reaction is nausea and/or diarrhea.  By listing penicillin as an allergy because the patient gets nausea or diarrhea after taking might lead to antibiotic failure or resistance which can be costly and prolong illness.

It’s important to keep in mind that the care that you receive by your medical providers when you are ill might be negatively impacted by an improperly labeled allergy in your medical records.

Rashes:  There are different kinds of rashes that can occur after taking penicillin or other antibiotics.  Some rashes such as hives are raised, intensely itchy and they come and go over hours. Another type of rash is flat, blotchy and spread over days but do not change by the hour and are less likely to represent a dangerous allergy.  These rashes start after several days of treatment.  We call these rashes a drug induced exanthem.  Taking a photograph of your rash and bringing it to your doctor may be helpful if the rash changes.

True Allergic Reactions:  hives, angioedema (swelling of the face/lips), throat tightness, wheezing, coughing, trouble breathing from asthma type reactions are all important to distinguish from “adverse reactions” as I mentioned above.  When you list a medication allergy, make sure you describe which of these symptoms that the medication caused.  These types of reactions only occur in 1-5% of people.  It is important to tell your medical provider if you have had any of these symptoms because a past history indicates that the patient might develop a more severe infection such as anaphylaxis in the future if given the medication again.

Anaphylaxis:  This is a true medical emergency caused by a potentially life-threatening allergic reaction.  The symptoms involve the allergic reaction as well as low blood pressure, trouble breathing, abdominal pain, swelling of the throat or tongue and or diarrhea/vomiting.

Penicillin Allergy Testing:  Testing for a penicillin allergy might be important ifin people who have a suspected penicillin allergy and require it to treat a life-threatening condition for which no alternative antibiotic is appropriate.  It may also be appropriate for people who have frequent infections and have suspected allergies to many antibiotics, leaving few options for treatment.  About 90% of patients tested will not have a penicillin allergy either because they lost the allergy over time or were never allergic in the first place.  We do not routinely do allergy testing in the primary care or urgent care setting, it is done under the supervision of an allergist.

Cephalosporin Allergy:  Allergic reactions are less common than reactions to penicillin.  People with a penicillin allergy have a small risk of having an allergic reaction to cephalosporins.  Cephalosporins are a class of antibiotics closely related to penicillin.  Some of these medications include cephalexin, cefaclor, cefuroxime, cefadroxil, cepradine, cefprozil, loracarbef, ceftibuten, cefdinir, cefditoren, cefpodoxime, and cefixime.

Treatment:  For true allergic reactions stopping the medications as soon as possible is obviously important.  The following is an example of what I might do for a severe allergic reaction, but it may differ if you go a different facility or depending on the circumstances.

For mild urticaria:  Observation and consider diphenhydramine 25-50 mg PO/IM or 25mg IV

For severe urticara:  Diphenhydramine 25-50mg PO/IM or 25mg IV, Corticosteroids/Solumedrol 80-125mg IV,  IV fluids and/or epinephrine at a dose of 0.3mg 1:1000 IM (Epi-Pen).  If giving epinephrine, I usually have the patient transported to the hospital because they will need monitoring for rebound allergic reaction once the epinephrine wears off.

For Laryngeal Edema:  Give O2 by mask 6-10L

For Anaphylaxis-like reactions:  Suction as needed, elevate legs, O2 10L by mask, IV fluids (NS or LR), and Epinephrine 1:1000 0.3mg IM (Epi-Pen).  For bronchospasm, add Albuterol MDI 2-3 puffs, Antihistamine: Diphenhydramine 25-50mg IM or IV and Corticosteroids/Solumedrol 80-125mg IV and await transport to the hospital

For Hypotension:  Elevate legs, Oxygen by mask, use IV fluids, Epi-Pen and await transport to the hospital

Vagal Reaction:  Elevate legs, 02 by mask at 10L, IV fluids (NS/LR wide open)

For Angina:  02 by mask at 10L, IV fluids:  Administer slowly, Nitroglycerine 0.4mg sublingually; may repeat p5 min x 3 doses, Morphine 2mg IV and await transport to the hospital

For hypertension:  02 by mast at 10L, IV fluids:  Administer slowly, Nitroglycerine 0.4mg sublingually, may repeat q5 minutes x 3 doses and await hospital transport

For seizures: Suction/Protect Airway and monitor for obstruction by tongue.  O2 by mask if not vomiting.  If caused by hypotension, treat accordingly and if uncontrolled consider anticonvulsant such as diazepam and await hospital transport

For hypoglycemia:  O2 by mask at 10L, IV fluids D5W or glucose tablet

I recommend that patients who have known severe allergies to insect or bee stings carry an EpiPen with them.

If you’d like more information about allergic reactions to medications, check out the American Academy of Allergy Asthma & Immunology website:  http://www.aaaai.org/conditions-and-treatments/library/at-a-glance/medications-and-drug-allergic-reactions.aspx

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

Resistance to antibiotics could bring “the end of modern medicine as we know it”, WHO claim

The world is entering an antibiotic crisis which could make routine operations impossible and a scratched knee potentially fatal, the head of the World Health Organisation has claimed.

shutterstock_120021052
Bacteria carried by humans are becoming increasingly resistant to antibiotics Photo: JOHN TAYLOR

By Hannah Furness

From:  The Telegraph

7:00AM GMT 16 Mar 2012

Margaret Chan, director general of the WHO, warned that bacteria were starting to become so resistant to common antibiotics that it could bring about “the end of modern medicine as we know it.”

As a result, she claimed, every antibiotic ever developed is at risk of becoming useless, making once-routine operations impossible.

This would include many of the breakthrough drugs developed to treat tuberculosis, malaria, bacterial infections and HIV/AIDS, as well as simple treatments for cuts.

Speaking to a conference of infectious disease experts in Copenhagen, Dr Chan said we could be entering into a “post-antibiotic era”.

Replacement medicines could become more expensive, with longer periods of treatment required to bring about the same effect, she added.

Dr Chan said: “Things as common as strep throat or a child’s scratched knee could once again kill.

“Antimicrobial resistance is on the rise in Europe and elsewhere in the world. We are losing our first-line antimicrobials.

“Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.

“For patients infected with some drug-resistant pathogens, mortality has been shown to increase by around 50 per cent.

“A post-antibiotic era means, in effect, an end to modern medicine as we know it.”

The stark warning comes shortly after the World Health Organisation published a new book warning of the “global crisis”, entitled “The evolving threat of antimicrobial resistance.”

It reads: “Bacteria which cause disease react to the antibiotics used as treatment by becoming resistant to them, sooner or later.

“A crisis has been building up over the decades, so that today many common and life-threatening infections are becoming difficult or even impossible to treat, sometimes turning a common infection into a life-threatening one.”

The paper blamed the current situation largely on the misuse of antibiotics, which are not prescribed properly and used too frequently and for too long.

It added that an “inexorable increase in antimicrobial-resistant infections, a dearth of new antibiotics in the pipeline and little incentive for industry to invest in research and development” had led to a need for innovation”.

The WHO has now appealed to governments across the world to support research into the antimicrobial resistance.

Antibiotic Superbugs CRKP and MRSA: Who’s at Risk?

By Lisa Collier Cool
Apr 07, 2011

Misuse of antibiotics has led to a global health threat: the rise of dangerous—or even fatal—superbugs. Methicillin-resistant Staphylococcus aureus (MRSA) is now attacking both patients in hospitals and also in the community and a deadly new multi-drug resistant bacteria called carbapenem-resistant Klebsiella pneumoniae, or CRKP is now in the headlines. Last year, antibiotic resistant infections killed 25,000 people in Europe, the Guardian reports.

Unless steps are taken to address this crisis, the cures doctors have counted on to battle bacteria will soon be useless. CRKP has now been reported in 36 US states—and health officials suspect that it may also be triggering infections in the other 14 states where reporting isn’t required. High rates have been found in long-term care facilities in Los Angeles County, where the superbug was previously believed to be rare, according to a study presented earlier this month. CRKP is even scarier than MRSA because the new superbug is resistant to almost all antibiotics, while a few types of antibiotics still work on MRSA. Who’s at risk for superbugs—and what can you do to protect yourself and family members? Here’s a guide to these dangerous bacteria.

Understanding different types of bacteria.

What is antibiotic resistance? Almost every type of bacteria has evolved and mutated to become less and less responsive to common antibiotics, largely due to overuse of these medications. Because superbugs are resistant to these drugs, they can quickly spread in hospitals and the community, causing infections that are hard or even impossible to cure. Doctors are forced to turn to more expensive and sometimes more toxic drugs of last resort. The problem is that every time antibiotics are used, some bacteria survive, giving rise to dangerous new strains like MRSA and CRKP, the CDC reports.

What are CRKP and MRSA? Klebseiella is a common type of gram-negative bacteria that are found in our intestines (where the bugs don’t cause disease). The CRKP strain is resistant to almost all antibiotics, including carbapenems, the so-called “antibiotics of last resort.” MRSA (methacillin-resistant staphylococcus aureus) is a type of bacteria that live on the skin and can burrow deep into the body if someone has cuts or wounds, including those from surgery.

Who is at risk? CRKP and MRSA infects patients, usually the elderly—who are already ill and living in long-term healthcare facilities, such as nursing homes. People who are on ventilators, require IVs, or have undergone prolonged treatment with certain antibiotics face the greatest threat of CRKP infection. Healthy people are at very low risk for CRKP. There are 2 types of MRSA, a form that affects hospital patients, with similar risk factors to CRKP, and another even more frightening strain found in communities, attacking people of all ages who have not been in medical facilities, including athletes, weekend warriors who use locker rooms, kids in daycare centers, soldiers, and people who get tattoos. Nearly 500,000 people a year are hospitalized with MRSA.

Keeping hospital patients safe.

How likely is it to be fatal? In earlier outbreaks, 35 percent of CRKP-infected patients died, Journal of the American Medical Association (JAMA) reported in 2008. The death rate among those affected by the current outbreak isn’t yet known. About 19,000 deaths a year are linked to MRSA in the US and rates of the disease has rise 10-fold, with most infections found in the community.

How does it spread? Both MRSA and CRKP are mainly transmitted by person-to-person contact, such as the infected hands of a healthcare provider. They can enter the lungs through a ventilator, causing pneumonia, the bloodstream through an IV catheter, causing bloodstream infection (sepsis), or the urinary tract through a catheter, causing a urinary tract infection. Both can also cause surgical wounds to become infected. MRSA can also be spread in contact with infected items, such as sharing razors, clothing, and sports equipment. These superbugs are not spread through the air.

What are the symptoms? Since CRKP presents itself as a variety of illnesses, most commonly pneumonia, meningitis, urinary tract infections, wound (or surgical site) infections and blood infections, symptoms reflect those illnesses, most often pneumonia. MRSA typically causes boils and abscesses that resemble infected bug bites, but can also present as pneumonia or flu-like symptoms.

How are superbugs related? The only drug that still works against the CRKP is colistin, a toxic antibiotic that can damage the kidneys. Several drugs, such as vancomycin, may still work against MRSA.

What’s the best protection against superbugs? Healthcare providers are prescribing fewer antibiotics, to help prevent CRKP, MRSA and other superbugs from developing resistance to even more antibiotics. The best way to stop bacteria from spreading is simple hygiene. If someone you know is in a nursing home or hospital, make sure doctors and staff wash their hands in front of you. Also wash your own hands frequently, with soap and water or an alcohol-based hand sanitizer, avoid sharing personal items, and shower after using gym equipment. The CDC has reports on Klebsiella bacteria and MRSA, discussing how to prevent their spread and has just issued a new report on preventing bloodstream infections.