In February, public health officials in the UK reported that three people there had recently contracted gonorrhea. The cases were caused by a resistant strain of the bacteria. One of the first dangers of a post-antibiotic era that is already well on its way here is the super gonorrhea.
The bacterium that causes gonorrhea has evolved to become more dangerous than before. Drug-resistant infections, commonly known as superbugs, directly killed 1.27 million people worldwide in 2019. Up to 160,000 Americans were killed by superbugs in 2010.
“If we don’t stem the tide here.... we may very well be looking at a near future where common infections that we used to treat easily are not as easily treatable anymore.”Our most vulnerable moments are when these resistant infections find us. Hospitals are a breeding ground for superbugs because patients are in poorer health and because antimicrobials are so widely used in these places. Hospitals and other health care settings are the focus of current efforts to stop superbugs.
It is a bit different. It is widespread and has become resistant to almost every drug we have thrown against it. Gonorrhea could become one of the first superbugs that people have to be on guard for.
The story of antibiotic resistance in general is mirrored by the story of super gonorrhea.
As soon as we start using antibiotics, that raises the risk ofbacteria learning how to evade the effects of antibiotics. The first drugs they used were sulfa drugs, and almost immediately doctors started seeing treatment failures, and it has gotten worse over time.
There were only two widely recommended antibiotics for gonorrhea, ceftriaxone and azithromycin, in recent years, as our arms race with the disease got to the point where there were only two widely recommended antibiotics for its standard treatment. Many countries, including the U.S., recommended a combination strategy of using both drugs at once after seeing a large percentage of strains with some resistance to azithromycin. A man in the UK was found to have a strain that was resistant to the combo. Two similar cases were reported in Australia.
A world without reliable antibiotics for gonorrhea means that more people will lose the chance to have biological children, and more babies born every year will lose their eyesight.The infections were traced back to Southeast Asia, which has led to speculation that the infections were linked to sex tourism. There isn't any clear evidence of that, according to an investigation of the cases by EU officials. Many developing nations don't have the ability to track antibiotic-resistant germs. It is possible that we won't see a rise in these pan-resistant infections until it is well underway.
The data we have on gonorrhea resistance is not looking good. The World Health Organization found that the rate of ceftriaxone resistance in 73 countries increased from the year before to the year after. Half of all gonorrhea infections in 2020 will be resistant to at least one antibiotic, according to the CDC. Ceftriaxone is the only remaining option for patients with uncomplicated gonorrhea, as the CDC and other organizations have stopped recommending it. Ceftriaxone resistance is low in the U.S., but that is not a guarantee that it will stay that way. The country's first known case of a gonorrhea strain carrying a well-known and emerging mutation to the drug was reported in December 2020, the same month that the CDC changed its guidelines.
About half of gonorrhea cases never experience symptoms at all, according to data. Sometimes it can be a gruesome experience, with a discharge from your genitals, bleeding or burning urination, and added between periods for women. It can reach the anus through oral sex. What happens when gonorrhea is not treated is the most dangerous aspect of the disease.
It can cause inflammation and damage to the reproductive system in men and women, which can lead to infertility. It can reach the bloodstream and spread to other places in the body, causing serious or fatal consequences. If it is passed from mother to child during delivery, it can cause blindness or even death. It increases the risk of contracting other STDs.
As gonorrhea becomes less treatable, life will become more frustrating for anyone who catches it. Two decades ago, a simple pill would have helped. People have to get a shot. It could take antibiotics with harsher side-effects that may still not work, especially for infections found in the throat or rectum, a worry with the few possible alternatives we have. We may not be able to treat it reliably in the future.
Infections would be allowed to persist and spread further if treatment failures were not fixed. Up to 300,000 people could die annually if resistant gonorrhea became widespread, according to Teodora Wi, a WHO expert specializing in sexually transmitted infections. Without reliable antibiotics for gonorrhea, more people will lose the chance to have biological children, and more babies will lose their eyesight every year.
There is hope that this worst-case scenario won't happen. There are four antibiotics that are close to being approved that could be used to treat gonorrhea. Only two of the four potential new antibiotics are from novel drug classes. That is a crucial distinction, becausebacteria will more easily develop resistance to new drugs that are similar to those already used.
An effective vaccine for gonorrhea would give more protection against the disease, while givingbacteria less chance to outsmart the latest drug. A vaccine for gonorrhea has been a challenge since people don't develop immunity naturally. There is at least one candidate being tested in Phase II trials that is thought to have overcome this hurdle, and last year, the same Oxford University team that developed a covid-19 vaccine announced work on their own candidate. A study published earlier this month found that teens and young adults who have been given a vaccine against meningococcal B are less likely to get gonorrhea.
The potential protection afforded by the meningococcal B vaccine is modest and it is not known how long it will last. The vaccine is only recommended for teens and young people who might be at higher risk of serious Meningitis. It's not clear whether the added protection for gonorrhea will change the recommendation. The options on the table are not sure-fire bets.
The most effective long-term strategy against gonorrhea would be to cut down on sexually transmitted infections. The trends are going in the wrong direction. In April, the CDC announced that gonorrhea cases had reached a new record high in the U.S. in 2020, with over 670,000 cases. According to a study this April, the annual rate of sexually transmitted infections has declined since the 1990s, but the absolute number of cases has continued to rise.
Gonorrhea is included in the stigma attached to catching any STD. The germ has been around for thousands of years, going under colorful names like the clap and the drip. Our current dilemma was not evolution or antibiotic resistance.
Rates of gonorrhea in the US had reached an all-time low a decade ago. The fact that we've been losing ground since represents a public health failure, in that we've failed to provide easier access to condoms, teach people to have safe sex, and help people get tested. Our health care system has been in decline for a long time. The crisis worsened during the covid-19 pandemic.
Antibiotic resistance touches every corner of medicine, including the covid pandemic. The response to the Pandemic has stretched the resources and the bandwidth capacity of all healthcare facilities, which has led to an increase of resistant infections as well.
From the very beginning, we knew that antibiotics were not the miracle they first appeared to be. Scientists have warned about resistance for decades and called for changes in how we use and develop resources. In the medical and agricultural world, antibiotics have continued to be used even when not needed.
There are many people and organizations who are devoted to fighting superbugs. New funding or incentive models could convince pharmaceutical companies to buy back into antibiotic development. Some people want governments to collectively develop antibiotics by themselves. It has to happen soon.
If we don't stem the tide here with the multiple types of actions that we're trying to push, we may very well be looking at a future where common infections are not as easy to treat.
Unless things change, super gonorrhea won't be the last.
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