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DoxyPep 100mg
Post-exposure prophylaxis to help prevent bacterial STIs.
- Take Within 72 Hours
- Cuts Bacterial STI Risk
- Simple As-Needed Dose
Metronidazole 500mg
Antibiotic for bacterial vaginosis and trichomoniasis.
- Treats BV & Trich
- Proven Antibiotic
- Short Treatment Course
Valacyclovir 500mg
Antiviral that controls and suppresses herpes outbreaks.
- Controls Outbreaks
- Daily Suppression Option
- Reduces Transmission
This means that the three most common STDs are now considered “urgent threats” because of their potential to become more widespread and incurable.
What does Antibiotic Resistant Mean?
In a nutshell, when a disease or infection becomes antibiotic resistant it means that many of the antibiotics once used to treat the condition successfully, no longer has an effect. Currently, the CDC recommends only one cure for gonorrhea: a combination of two powerful antibiotics.
The CDC recently released new guidelines for treatment of the STD and states that antibiotic resistance “has increased rapidly in recent years and has reduced treatment options.”
Most people today simply trust that antibiotics will be able to knock out any infection or STD, simply because they have been successfully used to fight infections for more than 75 years. But, bacteria has learned over time how to evolve, and fight back. What once worked well, no longer does the job of killing the bacteria.
A Bacterial Evolution
In a recent interview, Jeffrey Klausner, MD, an STD specialist and a professor of medicine and public health at UCLA’s David Geffen School of Medicine, explained that the bacteria organisms have fought back by changing their outer surface. When they do so, antibiotics do not recognize the bacteria as the enemy.
The bacteria can also start to produce new enzymes that break down the antibiotic, according to Klausner. Gonorrhea, he says, has a history of learning ways to evade antibiotics.
According to the CDC, gonorrhea, has developed resistance to nearly all of the antibiotics once used successfully as treatment. These include:
- sulfonilamides
- penicillin
- tetracycline
- fluoroquinolones – such as ciprofloxacin
“We are currently down to one last effective class of antibiotics, cephalosporins, to treat this common infection. This is an urgent public health threat because gonorrhea control in the United States largely relies on effective antibiotic therapy,” the CDC website states, “Given the bacteria’s ability to adapt and survive antibiotics, it is critical to continuously monitor for antibiotic resistance and encourage research and development of new treatment regimens for gonorrhea.”
How Common is Gonorrhea?
Gonorrhea is the second most commonly reported notifiable disease in the United States, according to the CDC. It is a major cause of pelvic inflammatory disease (PID), which can lead to serious medical issues in women, such as:
- tubal infertility
- ectopic pregnancy
- chronic pelvic pain.
In addition, studies have shown that gonococcal infections facilitate the transmission of HIV infection.
The latest statistics from the CDC are from 2015, indicating that a total of 395,216 cases of gonorrhea were reported in the United States, yielding a rate of 123.9 gonorrhea cases per 100,000 population. Since 2014, the rate of reported gonorrhea cases increased 12.8% since 2014, and increased 19.9% since 2011.
The highest rates among females were observed among those aged 20 – 24 years (546.9 cases per 100,000 females), and 15 – 19 years (442.2 cases per 100,000 females). Among males, the rate was also highest among those aged 20 – 24 years (539.1 cases per 100,000 males) and 25 – 29 years (448.8 cases per 100,000 males).
Naturally, the risk of contracting the disease is a combination of a person’s sexual behavior and the prevalence of the disease in the community in which they live.
Cases That Resisted Treatment
According to the CDC, more than 2 million people in the U.S. are afflicted with various types of antibiotic-resistant infections, which now include an increasing number of gonorrhea cases.
This means growing concern for the future. In the U.S., there are cases where it is clear that the current recommended treatment for gonorrhea may be weakening. In 2016, there were seven cases of the STD in Hawaii that showed resistance to the last line of treatment – alarming doctors and indicating a frightening new health challenge.
Although all patients were treated successfully using the recommended dual regimen, and no further cases have been identified since May, this cluster represents the first cases of decreased ceftriaxone susceptibility and very high-level azithromycin resistance occurring in the same isolate in the United States. Both the resistance pattern and the occurrence of a cluster of cases, which indicates the strain was able to spread, are cause for concern.
Though there is evidence that other STDs are becoming more resistant, gonorrhea is by far the most pressing concern. This is because there’s only one CDC-recommended treatment for it: a combination of two powerful antibiotics, azithromycin and ceftriaxone.
According to Klausner, there are several treatment options for both syphilis and chlamydia, so more options means there is less of a concern.
Changes to CDC treatment Guidelines
In an effort to extend and preserve the effectiveness of antibiotic cephalosporins for as long as possible, the CDC has constantly been evolving its STD Treatment Guidelines:
- In 2010, CDC changed its treatment recommendations to recommend dual therapy for the treatment of gonorrhea and increased the recommended dose of ceftriaxone to 250 mg.
- Following continued declines in cefixime susceptibility, CDC updated its recommendations in 2012 to recommend ceftriaxone plus either azithromycin or doxycycline as the only first-line treatment.
- CDC’s 2015 STD Treatment Guidelines now recommend only one regimen of dual therapy for the treatment of gonorrhea – the injectable cephalosporin ceftriaxone, plus oral azithromycin. Dual therapy is recommended to address the potential emergence of gonococcal cephalosporin resistance.
So far, the CDC has not received any reports of verified clinical treatment failures to any cephalosporin in the United States.
Through the years, each time that gonorrhea developed resistance to antibiotics, CDC revised its treatment guidelines to recommend other available and effective medications. But, there are now no highly reliable, widely available, affordable, and well-tolerated backup options available, making research into new drugs particularly urgent.
Recently, the new drug, ETX0914, has shown promising results for researchers. This drug works differently from any currently marketed antibiotic. As a single-dose oral therapy, it could be used as an alternative to ceftriaxone injection as a component of recommended therapy for gonorrhea, replacing the need for an injection.
CDC researchers contributed to the preclinical evaluation of the antibiotic by showing it was active in the laboratory against strains of gonorrhea that were resistant to other existing classes of drugs.
Here are the findings:
- In the randomized controlled trial reported today, researchers treated 179 participants (167 men and 12 women) for gonorrhea using ETX0914 alone.
- All patients that received 3 grams of ETX0914, and 98% of patients that received 2 grams were cured.
- A small number of patients (21 out of 179) reported side effects, but most were mild and primarily gastrointestinal.
“Our research team and study participants take the possibility of untreatable gonorrhea very seriously,” said Stephanie N. Taylor, M.D., professor of medicine and microbiology at Louisiana State University Health Sciences Center and the trial’s lead investigator. “We are very pleased with these results and look forward to seeing ETX0914 advance through additional clinical studies.”
What You Can do to Limit Your Risk
That saying an ounce of prevention is worth a pound of cure really does apply here. Knowing the facts helps:
- You can get gonorrhea by having vaginal, anal, or oral sex with someone who has gonorrhea.
- A safe sexual relationship is one that is long-term, mutually monogamous, and with a partner who has been tested and is negative for any STD.
- It is important to use latex condoms the right way every time you have sex.
How do I know if I have gonorrhea?
Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection.
Symptoms in women can include:
- Painful or burning sensation when urinating;
- Increased vaginal discharge;
- Vaginal bleeding between periods.
Some men with gonorrhea may have no symptoms at all. However, men who do have symptoms, may have:
- A burning sensation when urinating;
- A white, yellow, or green discharge from the penis;
- Painful or swollen testicles (although this is less common).
If you are sexually active, have an honest and open talk with your health care provider and ask whether you should be tested for gonorrhea or other STDs. This can be done as part of a regular doctor appointment where you address any other physical concerns. Embarrassment should not stop you from asking questions and getting tested.
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