STD Awareness: “Sounding the Alarm” Over Another Antibiotic-Resistant STD

In 2012, the New England Journal of Medicine ominously stated, “It’s time to sound the alarm.” What followed was a description of the evolution of gonorrhea to all antibiotics we have used to treat it, including the last ones we had left. They closed the article with a warning: “The threat of untreatable gonorrhea is emerging rapidly.”

This summer, just five years after that alarm bell was sounded, the New England Journal of Medicine’s prediction came true. Reports of untreatable gonorrhea surfaced, shared in a World Health Organization press release: “Data from 77 countries show that antibiotic resistance is making gonorrhoea — a common sexually-transmitted infection — much harder, and sometimes impossible, to treat.”

An STD most people haven’t even heard of is rapidly evolving antibiotic resistance.

So maybe we should listen when a medical journal talks about the need to “sound the alarm.”

Sexually Transmitted Diseases, the medical journal of the American Sexually Transmitted Diseases Association, did just that in an editorial called “Mycoplasma genitalium on the Loose: Time to Sound the Alarm,” which accompanied two studies detailing antibiotic resistance in a little-known STD called mycoplasma genitalium, or MG for short.

“Let me get this straight,” you might be saying. “First you’re telling me there’s an STD called MG, which most people haven’t even heard of, and now you’re telling me I already need to worry about antibiotic resistance?” 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