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

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?

pillsYou’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

STD Awareness: Mycoplasma genitalium

Image of Mycoplasma genitalium adapted from American Society for Microbiology.

“I’m not small, I’m just streamlined!” Image of Mycoplasma genitalium adapted from American Society for Microbiology.

In November and December of last year, headlines touting a “new” STD made an ever-so-minor flurry across the Internet. CNN referred to it as “mycoplasma genitalium, or MG” — Mycoplasma genitalium is the name of the teardrop-shaped bacteria that can cause several diseases in the urinary or reproductive tracts, such as urethritis and pelvic inflammatory disease.

M. genitalium is the smallest living organism known to science, having “devolved” from more complex organisms — but that doesn’t mean it can’t pack a punch! While these bacteria have surely been around for millennia, we only discovered them in the 1980s. Since then, we’ve known that M. genitalium fits the profile of a sexually transmitted pathogen — the only reason it made the news last year was that a team of British researchers published further evidence that this bug is indeed sexually transmitted and capable of causing disease.


Genital mycoplasmas can be cured — but a doctor needs to know what she’s looking for in order to prescribe the correct antibiotic!


An infection with M. genitalium could more generally be called a “genital mycoplasma.” The term “genital mycoplasmas” refers to a category of several different species of sexually transmitted bacteria, most notably Mycoplasma genitalium, but also less common species, such as Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. M. genitalium is considered an “emerging pathogen,” because it is only over the past couple of decades that technology has allowed us to study these bacteria, along with other genital mycoplasmas.

Risk factors for infection include multiple sexual partners and not using condoms during sex. It is thought that most people with an M. genitalium infection don’t have immediate symptoms — 94 percent of infected men and 56 percent of infected women won’t notice anything amiss. That doesn’t mean it can’t do damage. Continue reading

Over 90 Percent of What Planned Parenthood Does, Part 22: Expedited Partner Therapy for Chlamydia

200373577-001Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

So, you got chlamydia. It happens. In fact, it happens to an estimated 2.86 million Americans every year, and is the most common bacterial sexually transmitted disease (STD) in the country.


After testing positive for chlamydia, you can receive extra antibiotics to hand-deliver to your partner.


Your infection didn’t come out of thin air — you got it from somewhere. Maybe you have a new sex partner who wasn’t tested and treated for any STDs before you got together. Perhaps you’re in a non-monogamous relationship. You also could have had it for a while before you found out about it, during which time a partner might have unknowingly caught it from you. One reason chlamydia can spread so easily — by vaginal, anal, or oral sex — is because it usually doesn’t come with symptoms. Amazingly, most people with chlamydia don’t know they have it unless they take an STD test to screen for it.

But the fact remains: You got chlamydia. Now what? Continue reading

STD Awareness: The Latest on Gonorrhea

Neisseria gonorrhoeae, the bacterium that gangs up on your body to give it gonorrhea. Image: CDC

Neisseria gonorrhoeae, the bacterium that gangs up on your body to give it gonorrhea. Image: CDC

Gonorrhea is that guy with the funny name who’s always up to something new and mischievous. Last year, the New England Journal of Medicine declared that it’s “time to sound the alarm” in response to emerging strains of gonorrhea that are increasingly resistant to antibiotics. Then, earlier this year, the medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with cefixime, one of the last drugs we have in our anti-gonorrhea arsenal. It’s a great time to be a gonococcus — the type of bacteria that causes gonorrhea — but the humans they infect probably don’t see it that way.

Last month, this bad boy rose to the top of the Most Wanted list when the Centers for Disease Control and Prevention proclaimed antibiotic-resistant gonorrhea an “urgent threat” — the highest threat level, which gonococci share with only two other bacteria types. To give you some context, the much more famous superbug MRSA was categorized as a “serious” threat, one notch below “urgent.”


Antibiotic-resistant gonorrhea is an “urgent” threat; meanwhile, researchers develop a gonorrhea vaccine that works — on mice.


Antibiotic-resistant gonorrhea is especially insidious for two reasons. One, gonorrhea often doesn’t have symptoms, which allows it to jump from one sexual partner to another, the hosts often none the wiser. Two, unless health care providers actually test the bug’s DNA, they have no way of knowing whether or not they’re dealing with a drug-resistant strain. This opens up the possibility for treatment failure — and for the antibiotic-resistant bacteria to be further propagated into the community.

The CDC estimates that the United States sees 246,000 cases of antibiotic-resistant gonorrhea infections annually — that’s about 30 percent of all gonorrhea infections in the country. For now, we seem to be able to cure them with higher doses or different combinations of drugs. So why does antibiotic-resistant gonorrhea deserve the “urgent” designation? While gonorrhea isn’t associated with a body count — unlike other drug-resistant pathogens, which collectively kill at least 23,000 Americans a year — it can have terrible consequences. Gonorrhea can cause pelvic inflammatory disease (PID) when it advances up the female reproductive tract, and epididymitis when it invades the male reproductive tract; both conditions can cause infertility. Also, gonorrhea infections make us more vulnerable to HIV. The CDC estimates that if the most resistant gonorrhea strain gains ground over the next decade, the country could see an additional 75,000 cases of PID, 15,000 cases of epididymitis, and 222 HIV infections, costing us $235 million. Continue reading

STD Awareness: An Update on Antibiotic-Resistant Gonorrhea

Last year, we shared the fascinating and frightening story of the emergence of increasingly antibiotic-resistant gonorrhea, an STD caused by the gonococci bacteria. The sexually transmitted scourge, which we only so recently reined in with the development of antibiotics, has been performing some genetic gymnastics to defeat almost every drug we’ve thrown at it. We douse it with certain drugs, and the bacterium literally spits them back out at us, and it inactivates other drugs by snapping the active molecules in half. Sulfa drugs, penicillins, tetracyclines, fluoroquinolones — they all make a gonococcus heave a bored sigh. Luckily, cephalosporins were still an effective treatment, but recently there have been reports of stubborn gonorrhea infections caused by the latest and greatest (and some might say most hated) strain of gonococci.


The bacteria that cause gonorrhea continue to evolve, right under our noses!


Well, the story isn’t over — just like the bacteria that cause gonorrhea, the tale is rapidly evolving. The latest class of antibiotics that the gonococci are chipping away at is the cephalosporin family, which includes several chemically related drugs that work in similar ways — and that can likewise be defeated by microbes in similar ways. Cephalosporin-resistant gonorrhea was first reported in Japan and documented in a few European countries. The Japanese case that inspired the New England Journal of Medicine to declare last year that it was “time to sound the alarm” was an oral gonorrhea infection that was resistant to one member of the cephalosporin family: ceftriaxone.

Earlier this month, the prestigious medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with another cephalosporin: cefixime. Yeah, I know, you’d rather hear about Big Foot or UFO sightings, not evidence that something as real and unmythical as Gonorrhea 5.0 has landed in your back yard. Luckily, there’s plenty you can do to protect yourself from it, and we’ll tell you all about it toward the end of this article. (Spoiler alert: It involves using condoms!) Continue reading