Antibiotic Resistant Gonorrhea May Be Our Next Major Epidemic

In a press release from the World Health Organization, the claims were clear. Antibiotic resistant Gonorrhea cases were on the rise around the world, and our weapons caches to fight them are running thin. But does that mean we should shut our doors and live lives of celibacy? Perhaps not. Let’s take a look at what’s going on with the threat of Gonorrhea, what is being done to curb it, and some ways you can protect yourself.

The Gonorrhea Problem

It may surprise some to find that Gonorrhea is the second most commonly diagnosed illness reported to the Centers for Disease Control year over year. Across the world, and estimated 78 million people will get this sexually transmitted disease annually, and most will not recognize it. As a matter of course, many cases (about half) of Gonorrhea are “silent” and cause no outward symptoms but often increases the chances of women to have ectopic pregnancies and men to have lowered sperm count. This silence of symptoms often allows for the spread of the disease when individuals rely on symptoms, and not testing, to determine if they are infected with a sexually transmitted infection or not. In terms of symptoms, those that do have a clinical presentation of the disease often have urethral discharge (which is about as fun as it sounds), pain in the testicles as well as swelling (for men), and vaginal discharge and bleeding between periods for women. If left untreated, both men and women can develop scar tissue, severe abdominal pains (especially when using the bathroom) and even septicemia (where bacteria begin to infect the body by passing into the blood). In the past, this was combatted by a mix of antibiotics, but treatment options have begun to be limited over the years, and a Gonorrhea “superbug” has been cropping up around the world. But how has this happened?

What’s the difference between Gonorrhea and MDR Gonorrhea?

As mentioned earlier, both Gonorrhea and antibiotic resistant (also called Multiple Drug Resistant or MDR) Gonorrhea can go without symptoms, or have the same clinical symptoms. The key difference between them has been treatment. In the past, almost all Gonorrhea was able to be treated with the simplest of antibiotics, Penicillin. However, over time the bacteria mutated (often termed as “learned”) and adapted to produce an enzyme that broke down the antibiotic before the antibiotic broke the bacteria, or changed the cell wall makeup so that the antibiotic was ineffective. We, of course, then developed new antibiotics which in turn over decades became obsolete as the bacteria adapted.

Of course, if this was just due to exposure and uncompleted antibiotic cycles (which certainly don’t help) then at least in theory we could simply put a hard stop to sex for a few weeks and make sure antibiotic cycles are completed, right? Well, not quite. Neisseria gonorrhoeae, the bacteria which causes this disease is rare for a pathogenic bacteria (one that causes disease) in that it readily trades genetic information across different versions of themselves. This means that despite even the strictest adherence to what we can do, the current drugs that have shown some measure of effectiveness still, namely Fluoroquinolone, Azithromycin and Extended Spectrum Cephlasporin will falter and ultimately fail.

What can we do to stop Gonorrhea?

So, after showing that the bacteria that causes Gonorrhea is resilient and can adapt, it is reasonable to wonder how we can fight it, and to think the outlook is grim. However, this is not the case. Yes, there are issues, and yes, every level of society needs to work together to face this and other antibiotic resistant plagues that want to throw us back into the dark ages. But that is something that we, as a global community can do. At the individual level, everyone can make a few decisions that can greatly slow the advance of antibiotic resistant gonorrhea and the spread of disease in general. The good old mantra of “get tested, use condoms” is one that can be applied to this problem, as actively treating the cases of Gonorrhea we can, and avoiding the spread are two key ways to reduce what is already a global epidemic.

Likewise, sex education is critically important, as 70% of gonorrhea cases occur between the ages of 15 and 25 years of age. Lastly, selecting fewer partners or abstinence if practical are viable options for reducing spread. For those who do test positive, treatment of the disease is heavily encouraged, as is asking your doctor about Expedited Partner Therapy if your significant other has been exposed. As communities, we can report cases of Gonorrhea and spread information about the disease so that those who would otherwise not be tested (despite being positive) may do so, and open discourse on what are often seen as delicate, personal matters which should not be a matter of public discussion.

Lastly, we can ask of our governments and companies to further research into antibiotics, which has long been discouraged by market trends as antibiotics need to be cheap, and have a short sales lifecycle while often being incredibly expensive and complex to develop. Some countries have seen renewed interest in the field of antibiotic research by placing “bounties” on molecules which can be used effectively against disease. With everyone working together, even in the smallest ways, we may one day see Gonorrhea, both “normal” and drug resistant become a thing of the past.