STD Awareness: Gonorrhea’s Latest Dubious Honor

Wanted: Scientists who can develop novel antibiotics

A few years ago, the Centers for Disease Control and Prevention (CDC) put out a “greatest hits” list of antibiotic-resistant pathogens. More recently, in late February, the World Health Organization (WHO) followed suit with a dirty-dozen list of 12 “superbugs,” which was composed mostly of potentially fatal microbes that are becoming increasingly impervious to the drugs that once easily killed them. These are the bacteria WHO believes represent the greatest microbial threat to human health, and the list was compiled in the hopes of providing direction — and motivation — to pharmaceutical researchers who are desperately needed to develop new antibiotics.


Investing in antibiotic development now will save lives later.


A quick primer on antibiotic resistance: Antibiotics kill living organisms called bacteria, but like all living organisms, bacteria can evolve. Just as giraffes evolve longer and longer necks that allow them to eat more and more leaves, so too do bacteria evolve resistance to antibiotics. For example, a resistant bacterium can evolve the ability to spit out the drug before it has a chance to kill it, or it can evolve structural changes to its cell wall that make it impossible for the drug to attach to it.

One superbug, classified as an “urgent threat” by the CDC and a “high priority” by WHO, stands out from the pack. Unlike the other bacteria in these lists, an untreated infection with this bug isn’t thought to be deadly — but it still wreaks enough havoc to merit special attention from such esteemed bodies as the CDC and WHO. That bug is Neisseria gonorrhoeae, and you have one guess what disease it causes. (If you said gonorrhea, you guessed right.)

Over the years, gonorrhea has evolved resistance to every drug we’ve thrown at it. The last line of defense we have is the double-threat dual treatment of azithromycin and ceftriaxone. By using two drugs, we can delay the inevitable evolution of antibiotic resistance by attacking the bacteria in two vulnerable locations, rather than just one, making it more difficult for the bug to mount a defense and pass on its superior survival skills to subsequent generations. Unfortunately, just last fall, the CDC made the dreaded announcement: Cases of gonorrhea resistant to these two drugs — the last in our arsenal — are emerging.

The lists developed by the CDC and WHO also include such bugs as the “flesh-eating” Group A Streptococcus bacteria and the cancer-causing Helicobacter pylori. So why is N. gonorrhoeae lumped in with such scary-sounding microbes? Gonorrhea might not kill you, but if it’s not cured, it can cause serious damage. Untreated, 1 in 5 men with a gonorrhea infection will develop epididymitis, while up to 1 in 5 women with untreated gonorrhea will develop pelvic inflammatory disease (PID). Complications include infertility, ectopic pregnancy, and chronic pain. In the pre-antibiotic era, gonorrhea was a top cause of infertility, and without effective antibiotics we might find ourselves smack-dab in the “bad old days” of untreatable gonorrhea.

A gonorrhea infection also has the side effect of making it easier to transmit and acquire HIV. When a person with HIV has a gonorrhea infection, their viral load increases, making them more infectious. Furthermore, a gonorrhea infection can make one more vulnerable to HIV. Gonorrhea causes inflammation, which recruits CD4+ immune cells to fight infection — and CD4+ immune cells are HIV’s favorite target, increasing its chance of successfully infecting a new host.

The CDC estimates that, if cephalosporin-resistant N. gonorrhoeae comes to dominate the venereal landscape, we’ll see 75,000 additional cases of pelvic inflammatory disease, 15,000 cases of epididymitis, and 222 additional HIV infections over a 10-year period — and that’s just in the United States. Worldwide, where gonorrhea and HIV disproportionately affect developing countries, these problems could get even more out of control.

While novel gonorrhea cures — any cures — would be welcome, WHO specifically pointed to the need for new antibiotics that can be taken orally. Other than being able to avoid the pain of a needle, it might not seem that a pill could offer much advantage over an injection, but the availability of oral drugs opens up treatment options to people around the world, who might not have access to clean needles or trained health-care providers. So a new pill that could cure gonorrhea wouldn’t just be a blessing for needle-phobes in developed nations — it would be a boon to humanity worldwide.

The growing problem of antibiotic resistance, however, is bigger than just gonorrhea. The New York Times quoted WHO Assistant Director General Dr. Marie-Paule Kieny as saying, “We are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.” Translation: Investing taxpayer dollars into research and development will pay dividends down the road when those same taxpayers need access to lifesaving drugs for deadly infections. Currently, superbugs are responsible for killing an estimated 23,000 Americans and 25,000 Europeans annually. As drug resistance grows, so too will the body count.

WHO’s list also underscores the importance of preventing the rise of antibiotic resistance in the first place. By not prescribing unnecessary antibiotics, doctors can help preserve these drugs for when they’re really needed. By taking antibiotics correctly, patients can help ensure they’re not helping the bacteria infecting them to develop resistance. And by pushing for agricultural reform, citizens can help put the brakes on what many say is the irresponsible overuse of antibiotics, which are used to make cows, pigs, chickens, turkeys, and other animals gain weight quickly, expediting their slaughter.

Sexually active people should use barriers, such as condoms and dental dams, during vaginal, anal, and oral sex. They should also keep up-to-date on their STD status by receiving screening and treatment. You can drop by to pick up condoms, or make an appointment to be tested for gonorrhea, at any Planned Parenthood health center.


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