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

Over 90 Percent of What Planned Parenthood Does, Part 23: Preconception Counseling for a Healthy, Informed Pregnancy

Welcome 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.

pregnancyFew moments in life are as important and complex as when a woman makes the decision of whether and when to have children. There are many considerations to take into account when planning to conceive, many of which can affect not only the baby, but the mother as well.

Preconception counseling, a service of Planned Parenthood Arizona, can provide those who wish to conceive with valuable information about their own health, suggestions about how to best manage their wellness for pregnancy, and education about a range of outcomes (including the possibility of miscarriage). Preconception counseling can assist you in creating an environment focused on optimal health for both you and your future child.

These counseling services include:

  • targeted medical history with focus on teratogenic exposures, ethnic background, and family history
  • social history with focus on risk factors for sexually transmitted diseases (STDs), tobacco, alcohol, and street drug use
  • history of chronic illnesses
  • physical exam
  • labs as indicated (STDs, diabetes screening, etc.)
  • genetic counseling referrals as indicated
  • immunization review
  • folic acid utilization
  • review of current medications and possible hazardous exposures

The above list might seem long and detailed, but upon closer examination, you might not know what all of these things mean. What are teratogenic exposures? What does folic acid have to do with a healthy pregnancy? Let’s look at some of these topics in more depth. Continue reading

The Golden Rule of Consent … Ask

The following guest post comes to us via Erin Callinan, who is the training and technical assistance manager at the Arizona Coalition to End Sexual and Domestic Violence.

holding handsWhen we look at the issue of sexual violence and prevention, we cannot do so without talking about consent. But what does that actually mean? What does consent look and sound like? Ultimately, yes means yes!

Consent works best centered in communication in words; words in whatever language everyone involved can use and understand. Consent means that an agreement has been made between individuals prior to any sexual activity that clearly communicates what each person is comfortable doing.

Obtaining consent is an ongoing process of mutual communication as sexual activity progresses, regardless of who initiates it. So once somebody consents, are you good to go? Not necessarily. Because consent is a continuous process, it’s a good idea to keep checking in with your partner. Continue reading

STD Awareness: Gonorrhea, Women, and the Pre-Antibiotic Era

Penicillin, the first cure for gonorrhea, was developed for mass production in the 1940s.

Penicillin, the first reliable cure for gonorrhea, was mass produced in the 1940s.

It’s Women’s History Month, a time to reflect on the achievements of women worldwide — like Margaret Sanger, Rosalind Franklin, and Florence Nightingale, or contemporary heroes like Wangari Maathai. But it may also be a time to examine some of the sadder aspects of womanhood, including the increased burden gonorrhea imposes on women. While gonorrhea is no picnic for anyone, it wreaks the most havoc in female reproductive tracts. In fact, before antibiotics, gonorrhea was a leading cause of infertility — one 19th century physician attributed 90 percent of female infertility to gonorrhea. Not only that, but the effects of gonorrhea could seriously reduce a woman’s overall quality of life.


With gonorrhea becoming more resistant to antibiotics, the CDC warns of a return to the pre-antibiotic era.


Gonorrhea is described by written records dating back hundreds of years B.C. Ancient Greeks treated it with cold baths, massage, “cooling” foods, and vinegar. In the Middle Ages, Persians might have recommended sleeping in a cool bed with a metal plate over the groin. A bit to the west, Arabs tried to cure gonorrhea with injections of vinegar into the urethra. Kings of medieval England might have had their gonorrhea treated with injections of breast milk, almond milk, sugar, and violet oil.

Although gonorrhea is as ancient an STD as they come, because women rarely have symptoms while men usually do, for much of history it was mostly discussed in terms of men. The name gonorrhea itself derives from the ancient Greek words for “seed flow” — gonorrhea was thought to be characterized by the leakage of semen from the penis. This confusion inspired many misguided notions throughout the millennia, such as the idea that almost all women carried gonorrhea and transmitted it to their unwitting male partners. Continue reading

STD Awareness: The Latest on Gonorrhea

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

Over 90 Percent of What Planned Parenthood Does, Part 18: Cholesterol Testing

vegetablesWelcome 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.


It’s National Cholesterol Education Month.


Heart disease and stroke are leading causes of death in our country, and high cholesterol is a major risk factor for both of these conditions. Most people with high cholesterol don’t have it under control, even though it is both preventable and treatable. According to the National Cholesterol Education Program, adults 20 years of age and older should have their cholesterol checked every five years. And, with two out of three adults suffering from high cholesterol, keeping track of your cholesterol is important.

What is cholesterol?

plaqueCholesterol is a waxy substance, sort of like fat, that can coat the walls of your arteries, forming a “plaque.” This is also referred to as “hardening of the arteries” or atherosclerosis. You’ll often hear comments like, “Those fast-food cheeseburgers will clog your arteries” — regularly eating food that is high in saturated fat can increase the amount of cholesterol that circulates in your bloodstream, increasing your risk for health problems. When arteries have too much plaque, they narrow, and your heart has to work harder to pump blood through your body.

Our bodies need cholesterol to function, but they’re able to synthesize it themselves — unlike many vitamins and minerals, we can make our own cholesterol and don’t need to get it from food. Cholesterol comes in two types: “good” cholesterol, or high density lipoprotein (HDL); and “bad” cholesterol, or low density lipoprotein (LDL). “High cholesterol” refers to high levels of “bad” (LDL) cholesterol in the blood. LDL is what forms plaque in the arteries, while HDL prevents plaque buildup, likely by carrying the LDL to the liver, which processes it before it’s excreted from the body. Continue reading