Super Bug: Antibiotic Resistant Gonorrhea
Gonorrhea is a sexually transmitted infection (STI) that is becoming resistant to all known antibiotics that can treat it. The bacteria that causes gonorrhea, Neisseria gonorrhoeae, is adapting to the antibiotics, and higher doses are needed to kill off all of the bacteria, or they are failing to kill it off completely. By definition, an antibiotic is a medicine that either inhibits the growth and reproduction of a microorganism or inhibits and destroys a microorganism.
Some cases of gonorrhea have been identified as multidrug-resistant and can resist all known antibiotics that are used to treat this STD. This is a serious problem that partially stems from a combination over-prescribing antibiotics that are unnecessary for certain illnesses and patients not finishing all dosages of an antibiotic. Not completing an antibiotic often leaves some of the bacteria alive. The bacteria that survive are the strongest of that particular infection, so the patient now has durable and virile bacteria within them that have been exposed to a specific antibiotic and can replicate to survive it. This means that the next time they are prescribed that medicine, it frequently doesn’t work as well and additional time on the antibiotic or a higher dosage is needed to defeat the bacteria, if it can be killed off completely by that prescription at all.
In terms of antibiotic resistant (ABR) gonorrhea, the bacteria is being deemed more resistant than ever before and cases are becoming more common in the United States.
According to a report from the World Health Organization (WHO) in 2014 titled “Antimicrobial Resistance: Global Report on Surveillance”, Neisseria gonorrhoeae that resisted penicillin was identified in the 1970s in Asia. At the same time, a resistance to tetracycline was also identified. In the early and mid-1990s, high levels of the bacteria were noticed to be resistive towards fluoroquinolone antibiotics. These trends spread and have been noticed in all regions of the globe.
- During the 1940s, cases of gonorrhea that were resistant to sulfonamides were widespread, and their use was discontinued for treating this bacteria.
- In the 1980s, gonorrheal strains that resisted penicillin and tetracyclines became widespread.
- During the 1990s and 2000s, fluoroquinolones were used extensively.
- In 2007, the U.S. had a high enough percentage of gonorrhea cases that resisted fluoroquinolones to cause the Centers for Disease Control and Prevention (CDC) to reissue its treatment guidelines for the gonorrhea to last resort cephalosporins.
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The last remaining antibiotic option for treating gonorrhea via empiric monotherapy are third generation cephalosporins, and there are cases that even resist these prescriptions.
Third generation cephalosporins include the oral antibiotics Cefixime and Ceftriaxone. The report states that “The gonococcal strains of gonorrhea that are resistant to these antibiotics are also resistant to most other antibacterial drugs relevant for treatment….”
According to the CDC, “From 2006 through 2011 the percentage of samples exhibiting elevated minimum inhibitory concentrations increased from: 0 .1% to 1.4% for cefixime, and 0% to 0.4% for ceftriaxone.”
Unfortunately, ABR surveillance is often lacking in countries with high disease rates, so there is a widespread absence of reliable resistance data for gonorrhea where it is most needed. As such, there is inadequate knowledge of the extent of the spread of resistant gonococci.
The resistance to the last-resort third-generation cephalosporin drugs is quickly outpacing the development of alternative treatment, and no new major antibiotics have been developed in the past 30 years. The cost of creating a new antibiotic usually requires research and development that spans into hundreds of millions of dollars, if not more. Sadly, the cost of developing prescription drugs that treat, but do not cure a disease are more lucrative because chronic illnesses that recur or have recurring symptoms mean that patients are continue purchasing a drug for long periods of time, sometimes even a lifetime– these treatments are cash machines. Drug manufacturing companies are often more interested in going where the money is and spending research funds on these types of medications, rather than antibiotics.
Currently in the U.S., the optimal treatment of an uncomplicated gonorrhea infection involves two antibiotics in a combination therapy– an intramuscular shot of ceftriaxone (branded as Rocephin) and an oral dose of azithromycin (Zithromax; Z-pak). Gonorrhea used to be easily treated using penicillin.
This doesn’t mean that all cases of gonorrhea are no longer curable by any of the previous antibiotics that were once deemed optimal treatments. It simply means that cases of gonorrhea are becoming more difficult to destroy, so we need to discover new antibiotics to stay ahead of the ABR bacteria. Failure to do so could result in millions more people becoming infected in the future and little that will be able to be done about it.
When being treated for any STD with an antibiotic, it is imperative to complete all doses of the antibiotic and abstain from sexual contact while taking the medication, as well as for the days following the antibiotics until you are sure that you are cured. Talk to your doctor to see if follow-up testing is necessary, and make sure that your partner gets tested (and treated) as well, so that you do not become reinfected. Use condoms correctly and consistently during sex to help prevent gonorrhea.
Get tested for gonorrhea (and treated if necessary) today.
Medically Reviewed by J. Frank Martin JR., MD on October 1, 2018 - Written by STDcheck Editorial Team.
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