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: Ceftriaxone-Resistant Gonorrhea

syringeNestled 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

Illustration: CDC

Illustration: 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: 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: Is There an STD That Causes Maggots?

Update: In November 2014, another video of a maggot infestation in a woman’s genitals went viral. Many astute readers clued us in to some of the locations of this viral video, but after reviewing the websites, I declined to include an updated link because I found them to be pretty misogynistic and exploitative. The message remains the same, though — yes, it’s possible to get maggots in a vagina; no, it’s not directly caused by an STD; and no, it’s definitely not caused by a “superbug” strain of any STD. Continue reading to get the scoop on how maggots actually can infest genitals, and what we know about their connection to STDs.

Maggots grow up to be flies.

Maggots grow up to be flies.

Over the past couple of weeks, I’ve been confronted by two mysteries. The first was a collection of search terms that led curious Web surfers to our blog. Take a gander at them and see if you can tell why they raised my eyebrows:

  • new std that causes maggots
  • what is the new std superbug that causes maggots
  • stds that cause worms

There were dozens of similar searches leading to this blog, enough to make me take notice — and dig around.


Maggots infesting your genitals isn’t something you need to worry about.


First, the obvious: I Googled “STD maggots” and looked at what came up. While there was absolutely nothing to be found in the legitimate news media, there was a proliferation of recently published stories on websites that I’d never heard of, all containing the same unsourced viral video of someone removing maggots from someone else’s vagina. (Actually, I could only find stills — none of the websites I looked at had functioning video. Not that I was hugely motivated to find one that did.)

The accompanying articles described a female patient with a sexually transmitted disease (STD) said to be called “sex superbug,” an antibiotic-resistant bacteria, which caused maggots to grow in her vagina. While there is no STD formally called “sex superbug,” the original author was probably referring to antibiotic-resistant gonorrhea, which is caused by a strain of bacteria called Neisseria gonorrhoeae that has evolved resistance to the drugs we use to kill it. Someone would have to track down the video’s source, however, to confirm that the subject actually suffered from gonorrhea in addition to the infestation of maggots. Continue reading