Q Health: Is it the coming plague?

by Lynn Beltran in Q Health | 0 comments

The recent news in my little world of STDs seems to be focused on gonorrhea and it certainly is cause for concern. The news, more or less, revolves around the possibility that gonorrhea is no longer a treatable infection in some areas.

Neisseria gonorrhoeae, better known as gonorrhea, is a bacterial infection that is spread through sexual contact. Over the past three to four decades, gonorrhea has shown to mutate and develop resistance to several spectrums of antibiotic therapy, where mutations have occurred several times. The initial recommended treatment for gonorrhea involved penicillin and tetracycline. Resistance to these drugs emerged in the 1970s and 1980s and therefore, new treatment was recommended using a new spectrum of antibiotics known as fluoroquinolones.

Gonorrhea cases circulating in the late 1990s and early 2000s showed a new resistance to fluoroquinolones, and yet again a new recommendation from the CDC was initiated that involved treatment with cephalosporin antibiotics. But concern then rose because we knew that this was our last line of defense, the last line of antibiotics that would serve as an effective treatment. Of even more concern was the fact that there was not so much as a new drug on the horizon that had hopes of being an effective treatment.

As someone who works with STDs on a daily basis, this has been a real concern for me and for colleagues. I have shared this concern with patients in hopes of promoting preventive behavior change. I became truly concerned when news released by the CDC earlier this month indicated that cases of gonorrhea identified in Asia were showing a resistance to that last spectrum of antibiotics, the cephalosporins. Remember, this was our last line of effective drug interaction. Also, the CDC was suggesting that some laboratory samples of gonorrhea collected in the U.S. were not responding as well as before to the cephalosporin antibiotics.

So where does that leave us? Do we have to fear gonorrhea as the coming plague? First, I think it is important to remember that gonorrhea is not known as an STD likely to lead to death. It is one of our more common STDs, about 700,000 infections in the U.S. each year. The consequences of untreated infection in men are most commonly swollen testicles and painful urination, and can increase the risk of acquiring HIV. The problem with untreated gonorrhea is that it is likely to lead to scarring in the genital tract that can lead to sexual dysfunction, and yes that can lead to erectile dysfunction or incontinence. Right now, men are more likely to suffer from a disseminating gonorrhea infection, when it goes untreated for a length of time. This means that the bacteria move to other organs and areas of the body. Untreated gonorrhea in men can lead to cardiac infection and arthritis in the joints.

In the past, consequences from untreated infection such as erectile dysfunction and cardiac disease were rare. It is entirely possible that they were rare because we had effective antibiotics. These antibiotics were successful in treating localized infection before it went further; they were a defense that could effectively limit the length of time that someone was infected, and they were a defense that could minimize the number of people suffering long-term infection. With new mutations that are showing resistance to all antibiotics, it seems almost inevitable that the number of people who will suffer with long-term consequences will increase. The bottom line is more and more infected people will be circulating in our communities and our pool of potential sexual partners.

As with all STDs, effective individual prevention strategies involve monogamy with an uninfected partner and/or condoms. Being tested regularly is important, but you must ask yourself, if there is no treatment available, what will I do if I find out that I test positive?

To find out more about Neisseria gonorrhoeae, go to www.cdc.gov/std/gonorrhea/.