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

STD Awareness: Will STDs Go Away on Their Own?

teensCan gonorrhea go away without treatment? Does chlamydia eventually clear up? Can trichomoniasis go away on its own? These are the kinds of questions people pose to Google before Google sends them here — at least that’s what I learned by looking at the blog’s stats. They’re tricky questions to tackle, and for so many reasons.

Some viral STDs stay with you for life, such as herpes and HIV. Others, such as hepatitis B and human papillomavirus (HPV), can be prevented with vaccines but cannot be cured. It’s also possible for the immune system to defeat hepatitis B virus and HPV — but in some cases, these viruses are able to settle in for the long haul, causing chronic infections that can endure for life and even lead to cancer.


Left untreated, syphilis can kill, and gonorrhea can cause infertility.


Non-viral STDs, like chlamydia and gonorrhea, can be cured. However, they usually don’t have symptoms, or symptoms can come and go, making it seem like an infection went away when it actually didn’t. You can’t know your STD status without getting tested, and you can’t self-diagnose an STD based on symptoms and then assume the infection went away when symptoms subside. Getting tested can uncover a problem and clear the way for treatment.

Nonetheless, people want to know if an STD can go away by itself — but there aren’t many studies on the “natural history” of curable STDs like gonorrhea, chlamydia, and trichomoniasis. Studying the natural course of a curable infection would require that scientists put their subjects at risk of the dangers of long-term infection, and no ethics board would approve such an experiment. Continue reading

STD Awareness: Are Condoms Really Necessary?

condoms in packetsCondoms are one of the best ways for sexually active people to avoid sexually transmitted diseases (STDs), but many worry that people are becoming more lax about protecting themselves. There are all kinds of myths swirling around about condoms — such as that they aren’t effective or that they kill the mood. And, thanks to anti-HIV medications, some people no longer see condom use as a matter of life or death.

The Centers for Disease Control and Prevention (CDC) recently announced that 2014 saw record highs in chlamydia, syphilis, and gonorrhea, which is a stark reminder that condoms protect against more than just HIV. So, even if you’re using medications to protect yourself from HIV, remember that syphilis is making a comeback, and can cause serious damage or even death when untreated, and that gonorrhea is rapidly evolving resistance to the last good drugs we have to treat it. Condoms are just as relevant as ever!

HIV

In 2014, the CDC announced it would start using the term “condomless sex” instead of “unprotected sex” to recognize that people could engage in condom-free sex, but still protect themselves from HIV by using Truvada, or pre-exposure prophylaxis (PrEP). Truvada is the first drug approved by the FDA to prevent HIV, and it can be taken by HIV-negative individuals to help their body ward off the virus before an infection can establish itself. The pill must be taken daily — using it inconsistently reduces its effectiveness. Continue reading

STD Awareness: Mycoplasma genitalium

“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

STD Awareness: Can I Use Plastic Wrap as a Dental Dam During Oral Sex?

plastic wrapIf you read this blog — or any sexual health website, really — you’ll probably see dental dams getting a lot of props. A dental dam (not to be confused with a female condom) is a square piece of latex that can cover the vaginal opening or the anus. Anyone wishing to avoid the oral transmission of STDs like herpes, gonorrhea, HPV, syphilis, chlamydia, and intestinal parasites, dental-dam advocates say, should use a latex barrier. Most people, however, have probably never even seen a dental dam, and they are not widely used. Perhaps their unpopularity is related to myths about oral sex being safe sex (it’s not!); perhaps it’s due to dental dams being expensive or difficult to find.


Plastic wrap hasn’t been evaluated by the FDA for STD prevention, and no studies have assessed its effectiveness in reducing disease risk during oral sex.


Some safer-sex aficionados have found ways around that, though. They might cut the tips off of condoms and make incisions along the sides, creating little latex rectangles. An even easier and cheaper option lies in plastic wrap, which many people use as a barrier while performing cunnilingus (oral contact with the female genitalia) or rimming (oral contact with the anus). It is inexpensive, easy to find, odorless, and tasteless, and can be purchased without even a hint of embarrassment (unless perhaps your other purchases include duct tape, cucumbers, and clothes pins). And it can be pulled off the roll in sheets as long as your heart desires!

Planned Parenthood endorses the use of plastic wrap for oral sex when dental dams aren’t available. The Centers for Disease Control and Prevention and AIDS.gov both recommend plastic wrap for use during rimming. Health authorities, such as AIDS.gov and the Idaho Department of Health & Welfare, recommend non-microwavable Saran Wrap, because microwave-safe Saran Wrap has tiny pores to let out steam — which might also let viruses and bacteria through. Continue reading