STD Awareness: Is Gonorrhea Becoming “Impossible” to Treat?

Image: National Institute of Allergy and Infectious Disease

Health authorities have been worried about it for a long time now, and we’ve been following it on our blog since 2012. The boogeyman? Antibiotic-resistant gonorrhea, a strain of the sexually transmitted bacteria that is becoming more and more difficult to treat. Higher doses of the drug will be needed to cure stubborn cases of gonorrhea — until the doses can no longer be increased. Then, untreatable gonorrhea could be a reality.


“Little now stands between us and untreatable gonorrhea.”


The World Health Organization (WHO), in a press release last month, finally used the word “impossible” when describing treatment of antibiotic-resistant gonorrhea, referring to documented cases of gonorrhea that were “untreatable by all known antibiotics.” Worse, these cases are thought to be the proverbial “tip of the iceberg,” as there aren’t good data on antibiotic-resistant gonorrhea in many developing countries, where gonorrhea is more prevalent and epidemics could be spreading under the radar. Adding to this problem is the fact that gonorrhea rates are climbing worldwide, which is thought to be due to a number of factors, including the decline in condom use, the frequent absence of symptoms, inadequate treatment, and increasing urbanization and travel.

What will happen if gonorrhea can’t be cured? Your infection could clear up on its own, after a lengthy battle with your immune system, but we don’t know a lot about how long this could take (weeks? months? never?). Unfortunately, despite your immune system’s best efforts, gonorrhea doesn’t go out without a fight. Gonorrhea can lead to pelvic inflammatory disease, which can cause tissue damage to the reproductive organs resulting in infertility, ectopic pregnancy, and chronic pain. It can also cause scarring that blocks sperm’s movement out of the testes, resulting in epididymitis, which is associated with infertility, chronic scrotal pain, and testicular shrinkage. Furthermore, gonorrhea increases risk for HIV transmission and can be passed to a baby during childbirth. The CDC estimates that, in the United States alone, untreatable gonorrhea could cause 75,000 cases of pelvic inflammatory disease, 15,000 cases of epididymitis, and 222 extra HIV infections over a 10-year period. Worldwide, where gonorrhea and HIV disproportionately affect developing countries, these problems could get even more out of control. Continue reading

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.) Continue reading

STD Awareness: Fully Antibiotic-Resistant Gonorrhea Is on the Horizon

shot-in-armWe’ve been anticipating its arrival for years now, but earlier this fall, the Centers for Disease Control and Prevention (CDC) finally made an announcement: Cases of gonorrhea resistant to the last drugs we use to cure it are emerging.

Over the years, gonorrhea has evolved resistance to every drug we’ve thrown at it — sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and narrow-spectrum cephalosporins. The last line of defense we have is a one-two punch of a pair of antibiotics: 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.


Prevention is paramount: Stop the spread of antibiotic resistance by practicing safer sex!


Unfortunately, we could only stave off the inevitable for so long. At their conference in September, the CDC announced a cluster of gonorrhea infections that are highly resistant to azithromycin, and that fall prey only to high doses of ceftriaxone. As gonorrhea’s tolerance to ceftriaxone increases, the infection will get more and more difficult to cure.

This cluster of drug-resistant cases was identified in Honolulu in April and May of this year, with five infections showing “dramatic” resistance to azithromycin, as well as reduced vulnerability to ceftriaxone. The good news is that these cases were cured with higher-than-usual doses of antibiotics, but the bad news is that dosages can only climb so high before a drug is no longer considered to be an effective treatment. Continue reading

STD Awareness: Gonorrhea’s Ever-Growing Resistance to Antibiotics

Gonococci, the bacteria that cause gonorrhea.

Ever since the advent of effective antibacterial therapies less than a century ago, humans with access to these drugs can easily cure gonorrhea. Most of us in the developed world have forgotten that this disease was once a leading cause of infertility in women and blindness in babies — sulfa drugs and antibiotics not only erased these infections from our bodies, they also erased memories of gonorrhea’s dangers from our collective consciousness.


There are two drugs remaining to treat gonorrhea, and resistance to them is climbing higher as the years march on.


Unfortunately, thanks to their talent for genetic gymnastics, gonococci, the bacteria that cause gonorrhea, have been evolving resistance to every drug we’ve thrown at them — to tetracycline, to penicillin, and more recently to fluoroquinolones. One class of antibiotics remains to treat gonorrhea: cephalosporins. In 2013, Centers for Disease Control and Prevention (CDC) Director Tom Frieden warned that we could find ourselves in a “post-antibiotic era” – unless we take precautions. And, just two weeks ago, the latest study from the CDC’s Gonococcal Isolate Surveillance Project sounded the alarm that the post-antibiotic era is drawing ever closer, especially when it comes to gonorrhea.

Azithromycin and ceftriaxone, the two drugs that are used in combination to deliver a one-two punch to invading gonococci, are the best antibiotics remaining in our arsenal. Azithromycin is taken by mouth, while ceftriaxone is administered by a shot, and when taken together they team up to target different weak points in gonococci’s armor. Azithromycin interferes with the bacteria’s ability to make proteins, shutting the cells down, while ceftriaxone causes the cell wall to fall apart. However, the gonococci can acquire resistance. For example, in the case of azithromycin, a resistant bacterium can spit out the drug before it has a chance to kill it, or it can change the shape of its protein-making apparatus such that the drug can’t attach to it.  Continue reading

STD Awareness: Which STDs Are Resistant to Antibiotics?

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that is resistant to methicillin, as well as pretty much every other antibiotic out there. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.


There are drug-resistant strains of gonorrhea, trichomoniasis, and syphilis.


Evolution is the force behind life’s diversity. Normally, diversity is a good thing — but when it comes to microbes that cause diseases like gonorrhea, trichomoniasis, and syphilis, these organisms’ ability to evolve new defenses against our antimicrobial drugs isn’t good for us.

STDs have plagued us for millennia, but it wasn’t until the 20th century that we finally developed antibiotics, which gave us a powerful tool against many of our most formidable sexually transmitted foes. Suddenly, scourges like gonorrhea and syphilis could be quickly and easily treated with a dose of penicillin.

Problem solved, right? Nope. Enter evolution by natural selection. Continue reading

The Best of 2015: A Year of Blogging

Every week, we publish new material on the blog — a feat that would not be possible without the dedication and talents of our amazing volunteer bloggers! It is our not-so-humble opinion that the blog publishes high-quality, informative, insightful, and sometimes downright fun pieces, and the entire Planned Parenthood Arizona family is so proud to have it as a showcase. To commemorate another successful year of blogging, we asked our bloggers to pick their favorite posts from 2015.

holding hands from backRebecca usually writes about contraception, but in 2015 she conceptualized the new Teen Talk series, aimed at our younger readers but still plenty relevant to people of all ages. One of her favorite pieces was about the decision to abstain from sexual activity. While we live in a culture in which a lot of us feel pressure to have sex — even before we’re ready — we all have the right to make our own choices about sex, including the choice not to have it! For some of us, saying no can be hard, but can also be liberating. The issue of abstinence is highly fraught in our culture, but we love Rebecca’s deft and respectful handling of the topic.

gloria thumbnailAnne is our newest blogger, and we have been blessed by her lively prose! Anne’s favorite post was called Abortion: Don’t Ask, Don’t Tell, in which she wrote about the growing movement to fight stigma by “shouting our abortions” — rather than whispering about them or staying quiet. Given that 1 in 3 women has had an abortion yet the topic remains so taboo, the issue is largely shrouded in secrecy and silence. Anne shares her own story — and speaks powerfully about why it’s so important to shatter that silence once and for all. If “coming out” was so successful for the LGBTQ community, will it also help foster compassion and spread visibility for the many people who have had abortions?

breastfeedingCynthia was another new addition to the blogging team this year, and her debut post was also her favorite. In August, to celebrate National Breastfeeding Month, Cynthia shared her sweet story of breastfeeding and bonding. She wrote about how breastfeeding her son was the most “rewarding, challenging, frustrating, amazing, and empowering” thing she’s ever done. Breast milk has myriad benefits for both mother and baby, and Cynthia covered many of them in an informative post interwoven with her personal experiences and insights.

Stadium thumbnailMatt continues to write insightful posts about the intersection between the personal and the political. In August, Matt helped herald the football season with his look at how expanding the University of Arizona’s stadium shrunk abortion access in the state. As he so eloquently wrote, “Abortion was never meant to be a bargaining chip. It was sacrificed in 1974 to give more football fans a seat at the game. It’s time undo the damage and give more abortion supporters a seat in the legislature.” Whether you’re a Wildcats fan or simply interested in learning more about this chapter in reproductive-justice history, we think you’ll be fascinated (and enraged) to learn about the stadium deal.

Anna is a graduate student in health sciences who has carved out a niche for herself as our unofficial STD blogger. One topic she keeps coming back to is antibiotic-resistant gonorrhea, which is classified as an “urgent threat” by the Centers for Disease Control and Prevention. Thanks to the bacteria’s ability to evolve so quickly, we only have one good antibiotic left to cure this serious infection — and no new ones on the horizon. Find out how the bacteria that cause gonorrhea are able to evade our pharmaceutical arsenal, whether they’re having “bacteria sex” with one another or grabbing genes from their cousins. These bugs have a unique talent for altering their genes, which would be admirable if it weren’t so worrying!

Harvey Milk Day thumbnailMichelle celebrated Harvey Milk Day with a touching tribute to this pioneering LGBTQ leader, who would have blown out 85 candles on his birthday cake last May — if his life hadn’t been cut short in a senseless and tragic assassination in 1978. As one of the first openly gay politicians ever to be elected to public office, Milk sponsored an anti-discrimination bill, fought to establish daycare centers for working mothers, helped to increase low-cost housing options, and consistently advocated for the rights of all marginalized communities. Check out Michelle’s piece to learn more about Harvey Milk, what he accomplished, and why his legacy is so important to celebrate!

condom and hand thumbnailJon joined us early this year — first as an intern, and then as a volunteer blogger. We loved the piece he wrote about the place birth control has in his life, especially in a world in which the birth control burden can too often fall on women’s shoulders alone. Jon used condoms to take responsibility for his part in preventing pregnancy, and to boost the effectiveness of his partners’ birth control pills. With typical use, condoms and oral contraceptives can combine to be more than 98 percent effective! For Jon, birth control helped him plan his future, complete his education, and forge relationships — and condoms were an essential component of that toolkit.

standwithpp pic thumbnailKelley actually isn’t a Planned Parenthood volunteer — they’re our public policy manager! That didn’t stop them from contributing some strong pieces to the blog. For Trans Awareness Month, Kelley shared their journey to living authentically — a post that was both heartfelt yet humorous, personal yet universal. In Arizona, Kelley can be fired for their sexual orientation, gender identity, and gender expression — but feels lucky to have found a supportive home with Planned Parenthood. No matter what month it is, Planned Parenthood supports the trans community because we stand for autonomy over one’s own body, identity, and decisions.

STD Awareness: Ceftriaxone-Resistant Gonorrhea

Nestled in the throat of a Japanese woman was a collection of clones that scientists abducted from their temporary habitat and christened H041 — a humdrum moniker for a strain of bacteria that would burn headlines in medical journals. Though the bacteria never caused symptoms in their host, they lingered in her throat from at least January until April of 2009, when a swab finally tested negative. Rather than succumbing to repeated bombardment by an antibiotic called ceftriaxone, the infection probably just went away on its own — as oral gonorrhea infections tend to do.


Resistance to ceftriaxone, our last good gonorrhea drug, has been reported in Japan, Australia, Sweden, France, and Spain.


The emergence of antibiotic-resistant gonorrhea is considered one of the most pressing problems in infectious disease — just two years ago, the Centers for Disease Control and Prevention named it an “urgent threat.” We have one remaining first-line gonorrhea treatment left: extended-spectrum cephalosporins, which include cefixime, which is taken orally, and ceftriaxone, which is administered as a shot. Resistance to cefixime was first documented in 1999, leaving ceftriaxone as our best remaining option, and the CDC’s first choice for treating gonorrhea. There are no good alternatives to ceftriaxone remaining, which is why reports of ceftriaxone-resistant gonorrhea are so deeply troubling.

What made H041 special was that it was the first extensively drug-resistant strain of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. With an unusually high level of resistance to ceftriaxone — four to eight times higher than the previous record holder — the strain was also resistant to a slew of other antibiotics: penicillin and its relatives, fluoroquinolones, macrolides, tetracycline, trimethoprim-sulfamethoxazole, chloramphenicol, nitrofurantoin, cefpodoxime, cefixime, ciprofloxacin, and levofloxacin — and had reduced susceptibility to azithromycin to boot.

Another thing that made H041 special — as special as clones can be, anyway — is that it never reappeared. After its discovery, researchers in Kyoto and Osaka intensified their surveillance, trying to uncover it again and track its spread through the population. However, their search for H041 turned up empty handed. But other ceftriaxone-resistant strains have been documented around the world. Continue reading