Health

Uh-Oh: Super Gonorrhea Is Something You Have to Worry About Now

Published On 05/27/2016 Published On 05/27/2016
gonorrhea superhero illustration
Jason Hoffman/Thrillist

Try to set aside your latent contempt for the high school sex-ed teacher with uncertain, possibly questionable motives -- the aim is not to fear monger. But here's the reality of sex-related risks that they probably didn’t teach you in high school: they're constantly changing. Or, in the case of gonorrhea, the risk is literally mutating itself to become incurable.

Prepare yourself for the disease dubbed "super gonorrhea."

First, you need to understand regular old gonorrhea  

Gonorrhea infects an estimated 820,000 Americans annually, and is the second-most common STI in the US (after chlamydia); around the world, 106 million people are infected. That is a lot of gonorrhea!

Concern about this disease, caused by the bacteria Neisseria gonorrhoeae, is nothing new. In a 2nd-century effort to describe it, the prominent Greek physician Galen combined the words gonos (seed) and rhoia (flow) -- a misnomer/boner if there ever was one, as Doc Galen had mistaken pus for semen (hence "seed").

Of course, most of us know Neisseria gonorrhoeae by another name, too: "the clap." Your typical barstool explanation for this STI-sobriquet is that it's a reference to an old treatment: ridding the penis of pus by slamming a textbook down on it (clap!). Others maintain that its derivation is clapier, an arcane French word for brothel.

These days, though, a new strain of the disease has a more comprehensible moniker: so-called super gonorrhea, which scientists think will soon be totally incurable.  

Why don't the drugs work?

Gonorrhea may be nearly as old as civilization, but it's only been subjected to antibiotics since the 1930s. In the ensuing decades, it has developed immunity to many of them, and if the trend continues, it's likely that gonorrhea will effectively be an untreatable disease.

Take penicillin, for example, which was an effective treatment up until the 1960s. At that time, scientists observed that a few strains of gonorrhea had begun manufacturing an enzyme called penicillinase, which renders penicillin useless. Then, in the 1980s, strains of gonorrhea that did not make penicillinase also became resistant to penicillin -- by other means, such as chromosomal mutations.

So, in 1986, the CDC began monitoring antibiotic resistance in gonorrhea.

By 2010, almost 30% of the samples analyzed were resistant to the following antibiotics: penicillin, tetracycline, and ciprofloxacin (or some combo thereof), which means whole swaths of medicine that used to clear up the clap just fine now simply… don't work. At all.

Why has this happened? For a few reasons: one, as in the case of penicillin, is that antibiotics are often over-prescribed, and the more often bacteria are exposed to antibiotics, the more likely it is that some will develop resistance and continue spreading. If you take antibiotics when you have the sniffles, you're part of this problem -- but so is the doctor who gave them to you.

Another reason for antibiotic resistance is that doctors don't always prescribe the treatment considered most effective at the time of infection. For example: ciprofloxacin, a standard drug to treat gonorrhea in the 1990s, has not been recommended since 2005 due to its antibiotic resistance. Yet a study in the UK revealed that in 2007 it was prescribed to treat approximately 40% of cases there, and still 10% in 2011. In other words, there are some doctors who prescribe a medicine they should know doesn't work.

Yet another snag is that gonorrhea is often symptomless, so in cases when the initial treatment doesn't eliminate the infection, patients often are unaware and don't return to the doctor. 

Basically, this disease is developing resistance to drugs faster than we can change the standard of care.

And here's the really bad news: we're running out of drugs. If gonorrhea develops resistance to the last antibiotic Big Guns available, then there will be nothing left in the medical arsenal.

Translation: untreatable super gonorrhea.

What happens when there's no cure for gonorrhea?

If left untreated, gonorrhea can cause painful genital swelling, infertility, ectopic pregnancy (and blindness in the baby) -- or, if it spreads to the bloodstream, arthritis, dermatitis, and even death. It also makes you more susceptible to HIV and other infections.

Cases of total antibiotic failure in the treatment of gonorrhea are already here; 6.7% of patients treated at one Toronto clinic still had the disease after receiving the most potent class antibiotics we have -- the last line of defense. And that happened in 2013.

So what can you do? If you have sex, wear a condom (yeah, yeah, the oldest trick in the book). If you have a cold, don't take antibiotics. If you're prescribed antibiotics, for anything, finish the entire course. And if you get gonorrhea, go back to the doctor, get tested again, and make sure the treatment has worked. Get tested for STDs often if you have sex with multiple partners.

There's not much else, other than hoping the folks who research this stuff find a new, better treatment. In general, the way people develop natural resistance to diseases is through sex: mixing up genes with another person to produce a variety of results (with distinct rates of success) is how we evolve. But bacteria can change much faster, as they grow at an exponential rate by splitting and dividing instead of humping.

So gonorrhea is a worthy foe: not only has it demonstrated an ability to change its genes and survive, it's also transmitted by our own gene-changing act (sex). Or, put another way, the means by which we might evolve immunity to this disease is the same way it spreads.

Until we discover a new way to treat bacterial infections, super gonorrhea may be a fixture of sex-ed textbooks.

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John Marshall is a writer based in New York who is fortunate not to have succumbed to super gonorrhea. Follow him down alleyways, or @brunodionmarsh.

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