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How Antibiotic Resistance is Complicating Gonorrhea Treatment

Highlights 

  • More and more STI-causing bacteria, like various gonorrhea strains, develop antibiotic resistance.
  • We now have one option left to treat gonorrhea.
  • Antibiotic overuse is likely to be blamed for this worrying trend.
  • Many bacteria more dangerous than gonorrhea have become resistant to antibiotics.

Time is running out: Gonorrhea is evolving faster than our antibiotics, and the World Health Organization (WHO) is sounding the alarm. 

This urgent warning follows closely on the heels of a disturbing report from the Centers for Disease Control and Prevention, which revealed the emergence of ‘superbug’ strains of gonorrhea that are defying our last-resort treatments.

Antibiotic Resistance is on the Rise

Drug-Resistant Gonorrhea: An Urgent Public Health Issue

In Augusta 2016, WHO, the Geneva-headquartered public health agency of the United Nations, released a recommendation against the use of a class of antibiotics known as quinolones to treat gonorrhea. It based its recommendation on findings from across the globe of gonorrhea strains resistant to quinolones. 

Henceforth, said the WHO, the antibiotic of choice for gonorrhea treatment should be cephalosporins. This was the first change in the WHO’s guidelines for gonorrhea treatment since 2003, according to a report posted at NPR.org.

how antibiotic resistance happens

More and more bacteria are developing antibiotic resistance

Fewer Gonorrhea Treatment Options

Of the sharp reduction in the number of antibiotics effective against gonorrhea, the CDC warned that the future “emergence of cephalosporin-resistant gonorrhea would significantly complicate the ability of providers to treat gonorrhea successfully since we have few antibiotic options left that are simple, well-studied, well-tolerated, and highly effective.”

The federal agency responsible for protecting the health of Americans said it must remain vigilant to detect any further antibiotic resistance in gonorrhea, and it encouraged new research to find alternative treatments before we run out of gonorrhea treatment options. 

Gonorrhea is Widespread

Gonorrhea is a sexually transmitted infection (STI) caused by strains of Neisseria gonorrhoeae bacteria. According to the CDC, it’s the second most common notifiable disease in the United States, second only to chlamydia. A notifiable disease must be reported to government authorities under law. 

Gonorrhea can cause infections in the genitals, rectum, and throat, says the CDC, and it’s a common infection, particularly among young people between the ages of 15 and 24. And now we have fewer options to treat the disease.

Anyone sexually active can get gonorrhea, meaning that the only certain way to avoid the infection is to abstain from all forms of sexual activity, including vaginal, oral, and anal sex.

The best way to avoid exposure to this infection is to be in a long-term monogamous relationship with a partner tested and found to be free of the infection. Alternatively, you can significantly reduce your chances of getting gonorrhea by practicing safe sex and using latex condoms. Tests have shown that condoms provide an effective barrier against even the tiniest STI pathogens, according to the CDC.

 

Antibiotic resistance
This graphic shows some of the more common symptoms of gonorrhea in women and men, but it should be noted that many infected individuals are asymptomatic.

Gonorrhea Presents Additional Risks to Pregnant Women

Pregnant women should beware of infection with gonorrhea, which they can pass to the baby during delivery. To pregnant women, the CDC says: “It is important that you talk to your health care provider so that you can get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.”

Genital Gonorrhea Symptoms

Gonorrhea can be present in both men and women who show no symptoms of the infection. However, if they are present, symptoms in men can include a burning sensation while urinating, a white, yellow, or green discharge from the penis, and painful or swollen testicles. Although both men and women can be infected with gonorrhea yet show no symptoms, women are more likely to be symptomless. However, if they do have symptoms, those can include increased vaginal discharge, vaginal bleeding between periods, and a painful sensation when urinating.

Rectal Gonorrhea Symptoms

The symptoms of a rectal gonorrhea infection in both men and women can include anal itching, bleeding, discharge, painful bowel movements, and soreness. A urine test can confirm the presence of a gonorrhea infection, although in cases caused by anal or oral sex, your doctor may need to use swabs to collect samples from your rectum or throat to detect the presence of gonorrhea.

Antibiotic Overuse Fuels Gonorrhea Comeback

“Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling its spread.” – A.P.J. Abdul Kalam. 

The incidence of this disease was on a downward trend not that long ago. However, the emergence of antibiotic-resistant strains of gonorrhea bacteria has reversed that trend in the United States. 

In 2009, the national rate of gonorrhea cases per 100,000 people fell to a record low of 98.1, a far cry from levels approaching 500 cases per 100,000 people in the 1970s. 

However, over the following three years, the incidence of gonorrhea climbed steadily, reaching 106.7 cases per 100,000 people in 2012. By 2021, that number had risen to over 700,00 cases, or 214 per 100,000 people.

Antibiotic Resistance Leaves Only One Treatment Option

In 2010, the CDC said it had five recommended treatment options for gonorrhea. Today, there remains only one treatment option — and now that option is slowly failing

In their 2015 guidelines, the CDC recommended a two-pronged therapy for gonorrhea, consisting of one intramuscular injection of 250 milligrams of ceftriaxone taken concurrently with an oral dose of 1 gram of azithromycin. 

In 2021, azithromycin was dropped from the guidelines, partly because of its susceptibility to resistance. The CDC recommendation is currently a single intramuscular injection of 250 milligrams of ceftriaxone.

Antibiotic Resistance Gives Rise to Superbugs

Gonorrhea’s increasing resistance to treatment with antibiotics is a severe problem because the infection is so easily transmitted from one person to another. However, more and more previously effective antibiotics seem to be losing their effectiveness against superbugs that have found ways to dodge these drugs.

In May 2016, an article published by Scientific American reported on the case of a Pennsylvania woman with a urinary tract infection with bacteria that resisted treatment with colistin, long considered an antibiotic of last resort. Upon testing, scientists found that bacteria responsible for the woman’s UTI also possessed 15 genes for resistance to other antibiotics. 

Developments such as these are a warning that “many common infections may soon be untreatable,” according to the article.

Antibiotic resistance
The growing problem of antibiotic resistance makes it increasingly difficult to treat a wide array of bacterial infections.

 

The Ominous Implications of Antibiotic Resistance

Prior to the discovery of penicillin in 1928, people could die from a simple infection caused by a cut finger or a scraped knee. Antibiotics changed all that, and for decades, humans have enjoyed healthier and longer lives because of them.

However, that may soon change as increasingly greater numbers of infectious organisms are becoming resistant to our antibiotic arsenal.

As far back as 2013, the CDC could see the writing on the wall. That year, it released a list of the top 18 drug-resistant threats to the United States. It divided those threats into three categories: Urgent Threats, Serious Threats, and Concerning Threats.

That list was updated in 2019, when several organisms were upgraded to Urgent Threat status and a Watch List was added.

Urgent Threats

  • Carbapenem-resistant Acinetobacter
  • Candida auris
  • Clostridioides difficile
  • Carbapenem-resistant Enterobacteriaceae
  • Drug-resistant Neisseria gonorrhoeae

Serious Threats

  • Drug-resistant Campylobacter
  • Drug-resistant Candida
  • ESBL-producing Enterobacteriaceae
  • Vancomycin-resistant Enterococci
  • Multidrug-resistant Pseudomonas aeruginosa
  • Drug-resistant non-typhoidal Salmonella
  • Drug-resistant Salmonella serotype Typhi
  • Drug-resistant Shigella
  • Methicillin-resistant Staphylococcus aureus
  • Drug-resistant Streptococcus pneumoniae
  • Drug-resistant Tuberculosis

Concerning Threats

  • Erythromycin-resistant Group A Streptococcus
  • Clindamycin-resistant Group B Streptococcus

Watch List

  • Azole-resistant Aspergillus fumigatus 
  • Drug-resistant Mycoplasma genitalium 
  • Drug-resistant Bordetella pertussis 

This list makes it clear that the need to find alternative solutions has become urgent.  

The Search for Alternative Treatments for Infection

Researchers are hard at work to find alternatives to existing antibiotics that will treat the growing number of “superbugs.” A study conducted by Australian researchers found that rinsing and gargling with Listerine could help control the spread of gonorrhea. Another study concluded that gargling with Listerine can eliminate gonorrhea throat infection. 

However, these studies were conducted in 2016 and 2017, respectively, and they were tested only in the lab, not on humans. As far as we can tell, no further research has been done on this, and it’s important to note that Listerine is not mentioned in the CDC’s recommended treatment guidelines.

The National Institute of Allergy and Infectious Diseases (NIAID) is conducting and supporting research to develop new therapeutics against drug-resistant viruses, bacteria, parasites, and fungi and to identify alternative approaches. They are also exploring potential antimicrobial compounds from nature, including new classes of antibiotics found in soil. 

Scientists are also exploring alternative drug targets and therapies, such as combinational therapy, anti-regulator, anti-signal transduction, anti-virulence, anti-toxin, engineered bacteriophages, and microbiome to defeat antibiotic-resistant bacteria.

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