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

STD Awareness: Genetics and the Gonococcus

Image: CDC

Ever since the discovery of effective antibacterial therapies less than a century ago, humans have been able to easily cure gonorrhea, the sexually transmitted scourge that laid waste to fallopian tubes and robbed newborns of vision. 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 — and still is in much of the developing world.

Unfortunately, gonococci — the species of bacteria that cause gonorrhea — have been evolving resistance to every antibiotic we’ve thrown at them, including sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones, and narrow-spectrum cephalosporins. 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 — and resistance is emerging to those drugs, as well.


Gonococci don’t swap potato salad recipes at family reunions — they swap genetic material!


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,” and indeed, gonorrhea seems to be evolving resistance to drugs at quite a rapid clip. Gonococci can acquire resistance to antibiotics in three ways.

First, a genetic mutation can endow bacteria with special antibiotic-fighting powers, making it harder for a drug like penicillin to attach to their cells and destroy them. Such a mutant is more likely to gain evolutionary traction if it finds itself in an antibiotic-drenched environment in which resistance to that drug allows it to “outcompete” other bacteria. Indeed, antibiotic resistance was first documented in the 1940s, just years after sulfonamides and penicillin were introduced as the first effective cures for gonorrhea. Continue reading

STD Awareness: 10 Myths About Sexually Transmitted Diseases

The Internet is brimming with contradictory claims about sexual health, and you don’t know what to believe. Your friends give you advice, but you’re not sure if it sounds right. To make things worse, you might not have had evidence-based, medically accurate sex education in your school. In this edition of our STD Awareness series, we’ll take on a few myths about sexually transmitted diseases to help you sort fact from fiction.

1 MYTH: You can tell if someone has an STD by looking at them.
You might expect that if someone has an STD, their genitals would have blisters, warts, or noticeable discharge. But your partner looks fine, so you might think there’s no need to ask when his or her last STD test was.

However, while many people with STDs do have visible symptoms, they’re the exception rather than the rule. For example, three out of four women and half of men with chlamydia have no symptoms. Herpes is often spread when there are no symptoms present. Someone can be infected with HIV — and capable of transmitting it to others — and go years without showing any signs. A quick visual inspection can’t tell you very much about someone’s STD status.

2 MYTH: You can’t get an STD from oral sex.
While it is generally true that oral sex presents less of a risk for contracting STDs, this risk is not trivial. Most STDs can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes, human papillomavirus (HPV), and HIV. You can reduce your risk by using barrier methods like condoms and dental dams consistently and correctly.

3 MYTH: Condoms can’t prevent the spread of HIV.
Many proponents of abstinence-only education state that condoms don’t protect against HIV, claiming that latex condoms have holes that are large enough for viruses to pass through. This claim isn’t backed by evidence. An intact latex condom dramatically reduces your risk of being exposed to sexually transmitted viruses such as HIV. (It is true that a lambskin condom does not provide adequate protection against HIV.) Continue reading

STD Awareness: HIV and AIDS

Our immune systems are beautiful things, refined through millions of years of evolution. The immune system’s complexity is testament to the “arms race” that has been taking place between our species and the harmful pathogens that surround us. Last century, a virus called human immunodeficiency virus (HIV) emerged, and it found a weak spot in our immune system’s armor. HIV has been exploiting this weakness ever since, and an HIV infection can eventually progress to a disease called AIDS, or acquired immune deficiency syndrome. AIDS is a condition that disables our immune system’s ability to function properly, rendering us vulnerable to a host of opportunistic infections and cancers.


Even if you don’t think you’ve been exposed, HIV testing can be a good idea.


HIV is transmitted via bodily fluids: blood, semen, pre-seminal fluid (which can be present without ejaculation), breast milk, vaginal fluids, and rectal mucus. (It can also be present in bodily fluids like amniotic fluid, cerebrospinal fluid, and synovial fluid, to which health-care workers might be exposed.) The virus is not transmitted by fluids like snot, saliva, sweat, tears, and urine — unless blood is present.

Activities that can bring you into contact with HIV-infected bodily fluids include injection drug use and sexual activities like anal, vaginal, or oral sex. It can also be transmitted to a fetus or baby during pregnancy, childbirth, or breastfeeding. In the early days of HIV, many infections occurred as a result of blood transfusions or organ transplants — though nowadays this is a rarity thanks to tissue screening. Lastly, health-care workers might be exposed to HIV through accidents involving needlesticks or cuts. Continue reading

Practicing Safer Sex

Everyone who is sexually active is at risk for getting a sexually transmitted disease (STD). In fact, STDs seem so widespread that some health organizations predict nearly everyone could have an STD in their lifetime. The Guttmacher Institute reports that each year 1 in 4 teens contracts an STD. Untreated STDs can cause chronic conditions that could ultimately lead to infertility.

Practicing safe sex allows you to reduce your risks of getting an STD. Safe sex is not intended to eliminate spontaneity and passion, but is a way of enjoying sex without giving or getting STDs. It shows respect for yourself and your partner, and it must be practiced each and every time you have a sexual encounter.

Some ideas to make sex safer for you and your partner: Continue reading

STDs 101: An Introduction to Sexually Transmitted Diseases

Coupons for STD-screening discounts in April 2014 are available here.

It’s April, which for Arizonans means a gradual increase in temperature as we head toward summer. But at Planned Parenthood Arizona it also means that it’s time to focus on sexually transmitted diseases (STDs) in observance of STD Awareness Month. While we regularly provide information about sexual health with our monthly STD Awareness series, April is the time of year to fix the spotlight on sexually transmissible microbes and the infections they cause. April is also the time of year when Planned Parenthood Arizona offers coupons for discounted STD screening, so if you’ve been putting it off, now’s the time!

Symptoms of Sexually Transmitted Diseases

First, some basic facts. STDs can be transmitted through all sexual activities — vaginal, anal, or oral sex, as well as activities involving skin-to-skin contact. STDs are most commonly caused by viruses or bacteria, though they can be caused by other agents as well, including animals! Each STD is unique, with unique symptoms, but common symptoms include:

  • rashes, open sores, blisters, or warts in the genital area
  • swelling or tenderness
  • pus, bleeding, odor, or abnormal discharge
  • itching in the genital region
  • burning sensation during urination

It’s best not to focus too closely on symptoms, though — most people with STDs actually don’t experience any symptoms whatsoever! As they say in the biz, “The most common symptom of an STD is … no symptom.” For example, most people with herpes either have no symptoms or have mild symptoms that go unnoticed. Ten percent of males and 80 percent of females with gonorrhea don’t experience symptoms, and most people with chlamydia are asymptomatic. And HIV symptoms usually take a decade to show up. If you are, or have been, sexually active, you can’t assume that the absence of symptoms means you’re in the clear. To know for sure if you have an STD, the best thing you can do is to get yourself tested. Continue reading

STD Awareness: “Can I Get an STD from Oral Sex?”

As tools to reduce risk for STD transmission, dental dams are not to be ignored.

Editor’s Note: Other posts of interest to readers include: “Gonorrhea of the Throat,” “Oral Herpes,” “Can Oral Herpes Be Spread to Genitals?,” and “Can Oral Sex Cause Throat Cancer?

Many consider oral sex to be a safer form of sexual activity compared to vaginal or anal intercourse. For this reason, they might put less emphasis on the use of latex barriers, such as dental dams and condoms, during oral sex. Unfortunately, this idea is misguided and can lead to the transmission of preventable infections.

It is generally true that oral sex presents less of a risk for contracting sexually transmitted diseases (STDs) — but this risk is not trivial, especially when people are under the impression that they don’t need to use barrier methods during oral sex. Most sexually transmitted diseases can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes (which can be transmitted back and forth from the mouth, as cold sores, to the genital region, as genital herpes), human papillomavirus (HPV), and HIV. Even pubic lice can be transferred from the genital region to eyelashes and eyebrows! Additionally, intestinal parasites are more likely to be transmitted via oral sex than through vaginal sex. A microscopic amount of fecal matter containing parasites can be infectious, and can be unknowingly ingested when present on genitals.


Seventy percent of adolescents who reported engaging in oral sex had never used a barrier to protect themselves from STDs during oral sex.


Some bacterial STDs, such as gonorrhea and syphilis, can do permanent damage if not treated in time. Furthermore, gonorrhea of the throat is much more difficult to treat than gonorrhea in the genital or rectal areas. And some viral STDs can’t be cured (such as herpes and HIV), while others can cause chronic infections that have been linked to cancer (such as hepatitis, which is associated with liver cancer, and HPV, which is associated with throat cancer as well as cervical cancer and anal cancer). Continue reading