“Super Drug-Resistant” Gonorrhea Now Exists. Here’s What You Need to Know About It

The phrase “super drug-resistant gonorrhea” may sound like something from a scare-them-straight high school sex education video, but antibiotic resistance is a serious phenomenon and rising health risk worldwide—especially as it pertains to sexual health and the treatment of sexually transmitted infections (STIs).

Doctors have long been aware that gonorrhea, caused by the rapidly-evolving bacterium Neisseria gonorrhoeae, can become resistant to the drugs commonly used to treat it. The emergence of a case of “super drug-resistant” gonorrhea in the U.K. earlier this year, however, raised an alarm among doctors and scientists.

This case of antibiotic resistance is part of a much broader trend. Traditionally, gonorrhea has been fully treatable with the antibiotics ciprofloxacin and azithromycin, with oral cefixime and injectable ceftriaxone used as a last resort for particularly stubborn strains. Recently, however, according to the WHO Global Gonococcal Antimicrobial Surveillance Programme, resistance to all of these antibiotics has been on the rise. From 2009 to 2014, 97% of countries in the WHO survey reported instances of gonorrhea resistant to ciprofloxacin, 81% of countries reported resistance to azithromycin, and 66% reported resistance to cefixime and ceftriaxone.

While drug-resistance is a major public-health concern, it’s not without workable solutions. This “super drug-resistant gonorrhea”  has been successfully treated with another antibiotic—just not one commonly used for gonorrhea.

Meanwhile, scientists have begun making progress toward promising gonorrhea medications and vaccines, with innovative approaches targeting the process through which the bacteria sneak around human immune defenses. Finally, whether it’s a conventional strain or a “super drug-resistant” strain, gonorrhea can still be reliably prevented with something pretty simple: safe sex.

 

What should I know about gonorrhea?

Gonorrhea is a common sexually transmitted infection in the United States and around the world. As of 2016, gonorrhea was the second-most common STI in the United States, and rates of infection have been increasing. Gonorrhea can infect the genitals, rectum, and throat from unprotected sexual contact with the mouth, penis, vagina, or anus of an infected partner.

Often, the disease doesn’t present any symptoms at all. When symptoms are expressed, men may experience a burning sensation during urination, yellow or green penile discharge, or, less commonly, swollen testicles. Women may experience painful or burning urination, increased vaginal discharge, and spotting between periods. If you have any of these symptoms, you should contact your healthcare provider right away. Even if you aren’t experiencing noticeable symptoms, you should still get regular STI screenings. Gonorrhea can do long-term damage to your body even when it is asymptomatic.

If left untreated, gonorrhea can lead to pelvic inflammatory disease, long-term pelvic pain, or even infertility. Gonorrhea can also increase the risk of contracting or spreading HIV.

Everyone who is sexually active can contract gonorrhea, but young adults are at a particularly high risk. In the U.S., men aged 20-24 have the highest rates of infection of any age or gender group. Women aged 20-24 are also at high risk compared to women of other ages.

Most cases of gonorrhea are still easily treatable with antibiotics, so if you do contract gonorrhea there’s no need to freak out. If you’re ever worried about STIs, or you’re sexually active and haven’t had a checkup in a while, it’s a great idea to talk to your doctor about screening and treatment options.

 

What does it mean for a bacteria to be “drug resistant,” and why is this new strain “super?”

Antibiotic resistance is an example of evolution in action. While human evolution works on a timescale of hundreds of thousands or even millions of years, microbes evolve much more quickly due to their short life cycles. In many ways, the story of antibiotics has always been the story of antibiotic resistance, as scientists constantly race against the evolution of microbes to create new, more effective drugs.

When exposed to antibiotics, most strains of the targeted bacteria will die. However, a few organisms will have genetic mutations that allow them to survive the antibiotic and pass on the lucky genes to their offspring. Eventually, this mutation will become dominant in a population, meaning that human beings are increasingly infected with strains of bacteria that are difficult to treat through conventional means.

These emerging cases of gonorrhea are labeled “super drug-resistant,” or “multi-drug-resistant”, because they are resistant to all or most antibiotics usually used to treat the disease. That doesn’t mean that someone with “super drug-resistant” gonorrhea can never be cured. Treatment may take longer and be more complicated, however.

Overprescription of antibiotics can help spur antibiotic resistance. You can help prevent the spread of antibiotic resistance by making sure you’re using antibiotics appropriately and following your healthcare provider’s instructions. Viral infections, like a cold or the flu, can’t be treated by antibiotics, and you should never pressure your provider to prescribe an antibiotic when your he or she doesn’t feel it’s appropriate. When your provider does prescribe an antibiotic, make sure you follow their instructions exactly, taking the entire course of antibiotics. Finally, you can take preventative steps to reduce the need for antibiotics, like making sure you and your children are up to date on vaccines for bacterial infections like tetanus.

 

Are there any new treatments?

There are several promising drugs that are currently being developed to treat “super drug-resistant gonorrhea”. One potential antibiotic being developed at the University of York uses low doses of carbon monoxide in the body to stop the gonorrhea bacteria from respiring, or processing oxygen.

In another promising discovery, scientists at the University of Virginia have determined what makes Neisseria gonorrhoeae able to evade the body’s immune system in the first place. They found that the bacterium produces two proteins, called “lysozyme inhibitors”. These “lysozyme inhibitors” (you guessed it!) inhibit the function of lysozyme, an enzyme in human bodily secretions that kills bacteria. Scientists hope to develop a medication or vaccine that kills Neisseria gonorrhoeae by targeting these proteins.

The WHO has directed resources toward the problem of antibiotic resistance, founding the Global Antibiotic Research and Development Partnership (GARDP). Their Sexually Transmitted Infections Programme aims to support the release of an antibiotic that treats antibiotic-resistant gonorrhea by 2021.

 

How can I protect myself?

In the meantime, prevention of gonorrhea and other STIs remains the best cure. While antibiotic-resistant strains of gonorrhea may be new, safer sex practices are tried and true.

As with any STI, abstinence is the only way to stay 100% protected from gonorrhea. That said, limiting your number of sexual partners, practicing other kinds of sex (manual sex rather than oral, vaginal or anal sex, for example), and using condoms every time you have intercourse can also reduce your chances of infection. Finally, making sure you and your partners are regularly tested for STIs will help you catch any infections before they do lasting damage or spread to others.

While reports of a “superbug” are cause for concern, we are already armed with the best tools to prevent STIs from spreading. Public health measures that promote safer sex have proven to be enormously effective in halting the spread of STIs. Meanwhile, some of the best minds in science are on the trail of a drug-resistant gonorrhea cure. While bacteria mutate quickly, the human brain is the most super-powered weapon of all.

Want to learn more about your vaginal microbiome? uBiome’s SmartJane vaginal health screening test measures the levels of 23 different microorganisms in the vagina and screens for HPV and four other common STIs.