Story at-a-glance
- Gonorrhea is increasingly becoming resistant to available drug treatments, and as such may soon pose a major public health threat, according to a US Centers for Disease Control and Prevention (CDC) report
- The World Health Organization (WHO) already recognizes drug-resistant gonorrhea as “an emergency,” with several countries, including Australia, France, Japan, Norway, Sweden, and the United Kingdom, experiencing increasing infections
- Gonorrhea is one of 18 drug-resistant superbugs identified as “urgent, serious and concerning threats” to humankind
- Agricultural uses of antibiotics account for about 80 percent of all antibiotic use in the US; this low-dosage usage is implicated as a major contributor to the spread of antibiotic-resistant bacteria
- Each year, two million American adults and children become infected with antibiotic-resistant bacteria, and at least 23,000 of them die as a result
Cases of the sexually transmitted disease gonorrhea have been on the decline in the US since the 1970s. However, a new report from the U.S. Centers for Disease Control and Prevention (CDC) hints that this might not be the case for long.
Gonorrhea is increasingly becoming resistant to available drug treatments, and as such may soon pose a major public health threat. Antibiotic-resistant gonorrhea first emerged when I was in medical school in the late 1970s. By the 1980s, the antibiotics penicillin and tetracycline were no longer effective against it.
Next, gonorrhea resistant to fluoroquinolone antibiotics emerged, leaving only one class of antibiotic drugs, cephalosporins, left to treat it. Now, as you might suspect, gonorrhea is fast becoming resistant to cephalosporins – the last available antibiotics to treat it.
Drug-Resistant Gonorrhea May Soon Be a Major Public Health Threat
Gonorrhea infects about 820,000 people each year in the US. Although it often causes no symptoms, it may initially cause painful urination or discharge from thevagina or penis.
It used to be easy to cure gonorrhea with antibiotics, but increasing drug-resistant strains are changing the game, making this one STD that could put you at risk of permanent health damage. If left untreated, or if unable to be treated due to drug resistance, gonorrhea can cause pelvic inflammatory disease (PID) in women, leading to:1
- Formation of scar tissue that blocks fallopian tubes
- Ectopic pregnancy
- Infertility
- Long-term pelvic and abdominal pain
In men, gonorrhea may cause pain in the tubes attached to the testicles or lead to sterility. In rare cases, gonorrhea may also infect your blood or joints, which may be life threatening.
The World Health Organization (WHO) already recognizes drug-resistantgonorrheaas “an emergency,” with several countries, including Australia, France, Japan, Norway, Sweden, and the United Kingdom, experiencing increasing infections. As the CDC reported, if cephalosporin-resistant gonorrhea begins to spread in the US, it’s likely to increase incidence rates significantly.2
According to the CDC report, there are two reasons for the likely increased incidence. First, people may stay infected longer, which increases the chances of spreading it to others. Second, and even more worrisome, they noted that drug-resistant gonorrhea may have mutated to infect people even more easily:
“Mutational changes in the organism that conferred resistance or co-occurred with resistance determinants might have supported gonococcal transmission,” the CDC noted.
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The Last Remaining Treatment Option
Because of rising resistance, the CDC has changed the treatment recommendations for gonorrhea to a dual therapy involving an injectable cephalosporin and a second antimicrobial drug, given simultaneously. They describe this as “the only remaining recommended first-line treatment option for gonorrhea.”
Although cases of cephalosporin-resistant gonorrhea have not yet shown up in the US, it is already circulating in Japan and Europe — a similar trend to what happened when the last widespread resistance developed.
So as the CDC reported, it’s likely that even cephalosporins will soon become ineffective against gonorrhea. According to the CDC:3
“Neisseria gonorrhoeae has been remarkably adept at acquiring and maintaining resistance to antimicrobial drugs used for treatment, such as penicillin, tetracyclines, and fluoroquinolones (e.g., ciprofloxacin). After first spreading in Hawaii and California during the late 1990s and early 2000s, ciprofloxacin-resistant gonococcal strains became increasingly prevalent in the United States during the 2000s.
By 2007, the Centers for Disease Control and Prevention (CDC) no longer recommended ciprofloxacin or other fluoroquinolones for treatment of gonorrhea, which make the cephalosporins cefixime or ceftriaxone the only remaining recommended treatment option
…the possible emergence and spread of cephalosporin resistance could eventually threaten the effectiveness of this regimen and pose a major public health challenge.”
Drug-Resistant Gonorrhea Is One of 18 Emerging Superbugs Threatening Humankind
If the idea of drug-resistant gonorrhea concerns you, you’ll be equally alarmed to know there are many other resistant organisms “walking” among us. But, unlike gonorrhea, which is transmitted primarily through sexual contact, other drug-resistant pathogens are spread more readily – through contaminated food, water, or even dust particles.
The majority of the highly dangerous bacteria are in the Gram-negative category, because that variety has body armor that makes it extremely tough. Some forms are now exhibiting “panresistance”—meaning, resistance to absolutely every antibiotic in existence. In the CDC’s report “Antibiotic Resistance Threats in the United States, 2013,” the following 18 superbugs are identified as “urgent, serious and concerning threats” to humankind:4
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