STD Awareness: Will Gonorrhea Be Worse Than AIDS?

A scanning electron micrograph of a colony of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: Portland State University

If you’ve been reading the news lately, you might have noticed an odd piece of reportage from CNBC, in which a naturopath claimed that antibiotic-resistant gonorrhea “might be a lot worse than AIDS” and might cause cases of sepsis that could kill “in a matter of days.” This quotation, uttered by a single naturopath, was then exaggerated in sources such as the United Kingdom’s Daily Mail, which ran the headline “Doctors warn that antibiotic-resistant strain of gonorrhea could be ‘worse than AIDS.'” In fact, the only person making this claim was one naturopath, not a doctor, and certainly not plural “doctors.”

There’s a lot to unpack here. First is the alarmism in the original CNBC article, and its dependence on an unreliable source. Second is the issue of antibiotic-resistant gonorrhea itself, which is a very serious public health problem. Thirdly, let’s look at the naturopath’s claim, which is that antibiotic-resistant gonorrhea could unleash a plague worse than AIDS and kill its victims in a matter of days.

Claims that antibiotic-resistant gonorrhea will be “worse than AIDS” are greatly exaggerated.

Alan Christianson, the naturopath behind the hyperbolic claims of super-virulent gonorrhea, does not seem to be an actual expert in infectious disease (his website lists “natural endocrinology” and “male menopause” among his specialties), nor is he a medical doctor. The article identifies him as a “doctor of naturopathic medicine,” but what does that mean?

Naturopaths are not medical doctors, and degrees in naturopathic medicine aren’t awarded by institutions accredited by the Association of Medical Colleges, the body that accredits medical schools. Naturopathy is a philosophy that is not generally supported by scientific evidence, but rather is based in “a belief in the healing power of nature,” according to the National Center for Complementary and Alternative Medicine. It was developed in the 1800s and today encompasses many modalities of alternative medicine, including homeopathy and herbalism. For these reasons, it is odd that a journalist quoted a naturopath on the potential of antibiotic-resistant gonorrhea rather than someone more qualified, such as a microbiologist or epidemiologist.

The claims published by CNBC didn’t pass the smell test for Rachel Rettner of Live Science; she double-checked with actual experts in infectious disease and public health, who called the comparison to AIDS “misleading.” A couple of experts interviewed by the Huffington Post say that, while gonorrhea is more infectious than HIV — that is, it’s easier to catch from a single sexual encounter — it is in no way worse than AIDS and certainly not panic-worthy. For his part, Christianson claims that his quotation was taken out of context and that he was actually speculating about a hypothetical scenario in which antibiotic-resistant gonorrhea becomes more dangerous than it is now.

There is a big kernel of truth at the center of this story, though: Antibiotic-resistant gonorrhea is real, and is becoming an increasingly serious threat as we run out of effective antibiotics. It was only last year that the New England Journal of Medicine, not a publication whose editors are given to histrionics, declared that it was “time to sound the alarm” now that completely antibiotic-resistant gonorrhea is emerging as a realistic threat. A return to the era of untreatable gonorrhea could see an increase in particularly severe complications like pelvic inflammatory disease and epididymitis, which can affect fertility.

Then, earlier this year, The Journal of the American Medical Association reported the first North American sightings of gonorrhea that failed treatment with cefixime, one of the last effective antibiotics used for gonorrhea. These reports came from Toronto, where gonorrhea patients at a clinic were dosed with cefixime, but 9 out of 133 of them turned out to be infected with antibiotic-resistant bacteria.

While antibiotic-resistant gonorrhea infections have, so far, all been eventually cured — either with higher doses or different combinations of drugs — many public health experts fear that Neisseria gonorrhoeae, the bacteria that cause gonorrhea, are evolving resistance to antibiotics faster than pharmaceutical companies are developing new, effective drugs.

So, antibiotic-resistant gonorrhea is a threat — though not on the same level as AIDS — and, untreated, it can cause long-term problems, including infertility. But what about the naturopath’s claim that it might cause fatal sepsis (a bacterial invasion of the bloodstream)? A tour through the medical literature doesn’t turn up too much on gonococcal sepsis, and only two documented deaths connected to widespread gonorrhea infections can be found.

This 2001 case report describes a woman with multiple health problems, including a widespread gonorrhea infection, who suffered organ failure and died. A 1980 article describes a 19-year-old cancer patient whose spleen had been removed. During recovery, he awoke one morning suffering from chills, nausea, and fever, and was taken to the emergency department, where he suffered from a fatal cardiac arrest. He, too, was found to have a widespread septic gonorrhea infection. What isn’t clear is what role gonorrhea played in the patients’ deaths — the articles’ authors never made the definitive statement that one directly caused the other.

Although at least a few researchers believe that gonococcal sepsis is more common than reported in the medical literature, the evidence doesn’t support claims that gonorrhea can have fatal outcomes in anything other than the rarest of cases. While you should certainly take steps to avoid catching gonorrhea, it won’t be “worse than AIDS” and will not kill you “in a matter of days.”

More information about antibiotic-resistant gonorrhea is available from the Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases. Sexually active people should use latex barriers, such as condoms, during vaginal, anal, and oral sex. You can be screened and treated for gonorrhea (after providing a urine sample), or pick up condoms, at any Planned Parenthood health center. Researchers now believe that anyone treated for gonorrhea should be retested three months later as a precautionary measure.

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3 thoughts on “STD Awareness: Will Gonorrhea Be Worse Than AIDS?

  1. Pingback: Links 6/5/13 | Mike the Mad Biologist

  2. My general understanding is that any infection could lead to sepsis in the worst case. There are a lot of antibiotic-resistant bugs out there, and it’s a serious public health problem.
    I’m wondering if people who are treated unsuccessfully for gonorrhea, especially women who might not have noticeable symptoms, might be lost to follow up and then suffer complications.
    I read in some history book that gonorrhea in some cases can be wiped out by the immune system. That’s interesting, though it doesn’t make any sense now to wait and hope when we have effective treatments.

    • Well, the reason I looked through the medical literature was to see if gonococcal sepsis actually had killed anyone. Although it might have, it doesn’t seem like something to panic about. The fact of antibiotic-resistant gonorrhea is much more concerning, of course, but in the pre-antibiotic era, the worst complications were usually infertility and a form of arthritis. I didn’t come across records of people dying from it.

      Gonorrhea is wiped out by the male immune system (within months). I couldn’t find information on the natural history of gonorrhea in females, which seems odd given that we certainly studied it in the pre-antibiotic era; we should at least have some historical data to refer to. (I’ll keep looking!) A gonorrhea researcher told me that they conduct studies on males today (I think he said college students were paid $2,000 to be infected with gonorrhea for a few weeks), but studies on females are considered unethical because of the increased risk to fertility.

      Because of antibiotic resistance, the current recommendation is to be retested three months later to ensure successful treatment. I don’t know how many health care providers are actually doing that.

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