Gonorrhea: Resistance is Not Futile

Gonorrhea is back in the news, with headlines across the nation warning about it becoming a medication-resistant superbug.

Gonorrhea is a curable bacterial infection, for now. This bacterium has been with us primates at least since 2,600BCE, when the Chinese Emperor Huangdi, aka the Yellow Emperor, described it in his classic medical text. Hippocrates wrote about it as well, and in 1,100CE the English enacted strict laws trying to stop the spread of the disease. Once commonly called “the clap,” this communicable bacterium caused armies to lose wars.

Early treatments for gonorrhea included smacking the infected area (penis) with books to get the pus out, inserting alcohol-soaked eeds into it, using heat, mercury, oils extracted from tree sap and silver nitrate injected into the ureters and urethra. It wasn’t until 1943 that US military hospitals began using penicillin to treat gonorrhea. In 1946 four patients were documented with a strain that was resistant to penicillin, which is how far back the current challenge goes. The ‘60s brought new treatment with tetracycline. Gonorrheal resistance seems to develop after only a few years with every medication that has been initially effective.

You might wonder, why the concern now? We are running out of medication options to treat this infection. Bacteria have one goal, survival, so they naturally develop resistance whenever antibiotics or antimicrobials are introduced. Their presence puts a lot of pressure on the bacteria, forcing them to adapt to what’s attacking them to survive. The problem with antibiotics is they are equal-opportunity killers, unable to differentiate between good and bad bacteria. Their mission is to wipe out all bacteria, including those naturally occurring in our bodies that help us, leading to other kinds of health problems.

We call harmful bacteria pathogens. They want to live, so they develop their own strategies for survival. They develop proteins that can harden their survival mechanisms. Bacterial DNA is evolved to assist with survival. Bacteria can share their tricks and strategies for survival with other pathogens that have not even been exposed to antibiotics, making their pathogen friends wise to what can happen and how to prepare. They deliver their strategies firsthand.

Part of the resistance we’re seeing now is due to laboratory failures. Culture testing was once the standard, in which a sample would be placed on a nutrient plate, grown and then exposed to different antibiotics to evaluate what treatment would work to kill it. The decline in the use of culture testing and the inability of labs to perform this kind of test has created a challenge in early identification and detection of resistant strains.

Crazy, I know. So, what can we all do about this medication-resistant strain? Get tested! Gonorrhea can be asymptomatic in up to half of males and 75% of females. Untreated it can cause infertility and sterility by attacking the fallopian tubes in women, causing permanent scarring, and the urethra in men, causing scarring inside the penis. It can also cause pelvic inflammation in women, making intercourse painful.

Recently two cases of medication-resistant gonorrhea have been found in Massachusetts. Health officials identified the same strain in these individuals, who’d had no contact with one another, meaning there are others out there with a similar strain and likely unaware of their infection. These two people were eventually cured using Ceftriaxone, but the bug showed reduced vulnerability to this medication and others that were previously effective in curing gonorrhea.

How common is gonorrhea? Well, in 2020 there were 677,000 cases reported to the Centers for Disease Control, making it the number-two STI in the US. Given the high percentage of cases with no symptoms, the CDC estimated that the actual number of gonorrhea cases was more like 1.6 million. In addition it estimated that half the gonorrhea cases in 2020 were resistant to at least one antibiotic.

If you do experience symptoms of a gonorrhea infection, it could be burning while urinating, yellow or green discharge, swollen testicles, vaginal bleeding between periods, itching, pain or soreness of the anus. Sexually active people: please make a full sexually transmitted infection panel part of your annual healthcare exam. If you like having sex with multiple people and don’t like using protection, get a full-panel test done every three months. You’ll be helping to stop the spread of this STI and others.

This is Hedda Fay reminding you to get checked this year for all STIs, it’s important for your overall health. If you are diagnosed with an STI and receiving treatment, do not have sex with anyone (besides yourself) till you’ve completed your treatment, and best up to seven days after treatment stops, to help keep medication-resistant strains from developing.