On Friday, the World Health Organization (WHO) announced that the rise of antibiotic-resistant gonorrhea has made the sexually transmitted infection (STI) “much harder, and sometimes impossible, to treat.”
Considering that an estimated 78 million people get gonorrhea every year — in either their genitals, rectums or throats — their announcement might seem like a good reason to panic; after all, nobody wants an incurable super-gonorrhea inflaming our joints, making it painful to urinate and making us all go sterile.
But to better understand what’s happening, we contacted medical professionals and sexual health experts and took a closer look at the causes and possible solutions.
How is gonorrhea becoming more resistant?
If you feel like you’ve heard about antibiotic resistant forms of gonorrhea before, that’s probably because gonococcal, the microorganism that causes gonorrhea, constantly evolves and becomes resistant to different antibiotics, says Dr. Teodora Wi, Medical Officer of Human Reproduction at the WHO.
“The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” Dr. Wi said.
Thus, every couple of years, the LGBT blogosphere catches wind of new type of antibiotic-resistant gonorrhea.
This video explains some of the biology behind antibiotic resistant gonorrhea:
Keep in mind, that this sort of evolution isn’t unique to gonorrhea. Ever since the invention of penicillin, all sorts of infectious agents have been adapting to survive new medications.
“Antibiotic activity and antibiotic resistance are like credit and debt,” says Kent Sepkowitz, a New York physician who writes about medicine. “You can’t have one without the other.”
For example, in the mid 1940s, doctors used to prescribe penicillin to cure gonorrhea. But by 1989, gonorrhea had adapted to a point where it took it dose of penicillin 100 times greater than what was needed in the 1940s just to cure it. Eventually, doctors stopped prescribing it altogether because it just stopped working.
All sorts of bacteria can quickly mutate in ways that make them immune to antibiotics. And they can then pass on that immunity to different kinds of bacteria, quickly building resistant strains that can easily get passed on to others.
Who’s to blame for antibiotic resistant gonorrhea?
Well, no one and everyone.
“People like to have sex,” Sepkowitz said, “and with each condom-free act, bacteria swarm from this body part to that again and again.”
“Simply put,” he continued, “the sheer velocity of people hooking up has overwhelmed our flimsy antibiotic defense.”
But while condoms, abstinence and a reduction in sexual partners can reduce gonorrhea transmissions, Sepkowitz discourages people from thinking that condomless sex is to blame.
“Our insistence that we are the ones driving this enormous complex over the cliff disregards the basic facts (of bacteria’s adaptability),” he says.
Furthermore, not everywhere in the world has sexual health public awareness campaigns or trained health workers to help inform others on how to prevent or treat gonorrhea. Many parts of the world also have a stigma against STIs that creates barriers to people getting tested and seeking treatment.
The WHO also says, “There are no affordable, rapid, point-of-care diagnostic tests for gonorrhea. Many people who are infected with gonorrhea do not have any symptoms, so they go undiagnosed and untreated.”
Complicating matters, sometimes untrained doctors will assume that anyone experiencing painful urination or genital discharge has gonorrhea and will prescribe antibiotics, even when the patients actually have a different kind of infection.
When that happens, the other bacteria in the body can develop an antibiotic resistance and pass on the resistance to gonorrhea if a person ends up contracting it later on.
What role do pharmaceutical companies play?
A big one. In short, pharmaceutical companies aren’t developing new antibiotics to treat these antibiotic resistant strains of gonorrhea.
The WHO says that the research and development pipeline for gonorrhea is “relatively empty, with only three new candidate drugs in various stages of clinical development” — solithromycin, zoliflodacin and gepotidacin.
“The development of new antibiotics is not very attractive for commercial pharmaceutical companies,” the WHO says. That is, there’s not much money in it.
But if the antibiotic-resistant strains continue to proliferate, that may create a financial motive for drug companies to create more treatment options.
The only hope of ultimately beating gonorrhea would be a rapid detection tool and a vaccine, says the WHO’s antimicrobial expert Marc Sprenger.
In the meanwhile, it remains important to get tested and treated for gonorrhea and other STIs at least every three to six months.
Dr. Pamina Gorbach, a professor in the Department of Epidemiology at UCLA’s Fielding School of Public Health explains:
“It is best for men to get regularly tested for STIs because about half of those who get gonorrhea will not experience symptoms. If they test positive they should finish their course of antibiotics fully, and tell their sexual partners to also get tested and treated so they don’t just reinfect each other.”
Finishing the full course of antibiotics ensures the destruction of all gonorrhea bacteria in the body, reducing the likelihood that one will gain immunity and become a resistant strain.
Featured image by jarun011 via iStock