STD Awareness: Is Gonorrhea Becoming “Impossible” to Treat?

Image: National Institute of Allergy and Infectious Disease

Health authorities have been worried about it for a long time now, and we’ve been following it on our blog since 2012. The boogeyman? Antibiotic-resistant gonorrhea, a strain of the sexually transmitted bacteria that is becoming more and more difficult to treat. Higher doses of the drug will be needed to cure stubborn cases of gonorrhea — until the doses can no longer be increased. Then, untreatable gonorrhea could be a reality.


“Little now stands between us and untreatable gonorrhea.”


The World Health Organization (WHO), in a press release last month, finally used the word “impossible” when describing treatment of antibiotic-resistant gonorrhea, referring to documented cases of gonorrhea that were “untreatable by all known antibiotics.” Worse, these cases are thought to be the proverbial “tip of the iceberg,” as there aren’t good data on antibiotic-resistant gonorrhea in many developing countries, where gonorrhea is more prevalent and epidemics could be spreading under the radar. Adding to this problem is the fact that gonorrhea rates are climbing worldwide, which is thought to be due to a number of factors, including the decline in condom use, the frequent absence of symptoms, inadequate treatment, and increasing urbanization and travel.

What will happen if gonorrhea can’t be cured? Your infection could clear up on its own, after a lengthy battle with your immune system, but we don’t know a lot about how long this could take (weeks? months? never?). Unfortunately, despite your immune system’s best efforts, gonorrhea doesn’t go out without a fight. Gonorrhea can lead to pelvic inflammatory disease, which can cause tissue damage to the reproductive organs resulting in infertility, ectopic pregnancy, and chronic pain. It can also cause scarring that blocks sperm’s movement out of the testes, resulting in epididymitis, which is associated with infertility, chronic scrotal pain, and testicular shrinkage. Furthermore, gonorrhea increases risk for HIV transmission and can be passed to a baby during childbirth. The CDC estimates that, in the United States alone, untreatable gonorrhea could cause 75,000 cases of pelvic inflammatory disease, 15,000 cases of epididymitis, and 222 extra HIV infections over a 10-year period. Worldwide, where gonorrhea and HIV disproportionately affect developing countries, these problems could get even more out of control. Continue reading

STD Awareness: Gonorrhea’s Latest Dubious Honor

Wanted: Scientists who can develop novel antibiotics

A few years ago, the Centers for Disease Control and Prevention (CDC) put out a “greatest hits” list of antibiotic-resistant pathogens. More recently, in late February, the World Health Organization (WHO) followed suit with a dirty-dozen list of 12 “superbugs,” which was composed mostly of potentially fatal microbes that are becoming increasingly impervious to the drugs that once easily killed them. These are the bacteria WHO believes represent the greatest microbial threat to human health, and the list was compiled in the hopes of providing direction — and motivation — to pharmaceutical researchers who are desperately needed to develop new antibiotics.


Investing in antibiotic development now will save lives later.


A quick primer on antibiotic resistance: Antibiotics kill living organisms called bacteria, but like all living organisms, bacteria can evolve. Just as giraffes evolve longer and longer necks that allow them to eat more and more leaves, so too do bacteria evolve resistance to antibiotics. For example, a resistant bacterium can evolve the ability to spit out the drug before it has a chance to kill it, or it can evolve structural changes to its cell wall that make it impossible for the drug to attach to it.

One superbug, classified as an “urgent threat” by the CDC and a “high priority” by WHO, stands out from the pack. Unlike the other bacteria in these lists, an untreated infection with this bug isn’t thought to be deadly — but it still wreaks enough havoc to merit special attention from such esteemed bodies as the CDC and WHO. That bug is Neisseria gonorrhoeae, and you have one guess what disease it causes. (If you said gonorrhea, you guessed right.) Continue reading

STD Awareness: Is Chlamydia Bad?

chlamydiaPerhaps your sexual partner has informed you that they have been diagnosed with chlamydia, and you need to get tested, too. Maybe you’ve been notified by the health department that you might have been exposed to chlamydia. And it’s possible that you barely know what chlamydia even is, let alone how much you should be worried about it.

Chlamydia is one of the most common sexually transmitted diseases (STDs) out there, especially among young people. It can be spread by oral, vaginal, and anal sex, particularly when condoms or dental dams were not used correctly or at all. It is often a “silent” infection, meaning that most people with chlamydia don’t experience symptoms — you can’t assume you don’t have it because you feel fine, and you can’t assume your partner doesn’t have it because they look fine. If you’re sexually active, the best way to protect yourself is to know your partner’s STD status and to practice safer sex.


Chlamydia increases risk for HIV, leads to fertility and pregnancy problems, and might increase cancer risk.


The good news about chlamydia is that it’s easy to cure — but first, you need to know you have it! And that’s why it’s important for sexually active people to receive regular STD screening. Left untreated, chlamydia can increase risk of acquiring HIV, can hurt fertility in both males and females, can be harmful during pregnancy, and might even increase risk for a certain type of cancer. So why let it wreak havoc on your body when you could just get tested and take a quick round of antibiotics?

To find out just how seriously you should take chlamydia, let’s answer a few common questions about it.

Can Chlamydia Increase HIV Risk?

Chlamydia does not cause HIV. Chlamydia is caused by a type of bacteria, while HIV is a virus that causes a fatal disease called AIDS. However, many STDs, including chlamydia, can increase risk for an HIV infection, meaning that someone with an untreated chlamydia infection is more likely to be infected with HIV if exposed to the virus. Continue reading

STD Awareness: Will STDs Go Away on Their Own?

teensCan gonorrhea go away without treatment? Does chlamydia eventually clear up? Can trichomoniasis go away on its own? These are the kinds of questions people pose to Google before Google sends them here — at least that’s what I learned by looking at the blog’s stats. They’re tricky questions to tackle, and for so many reasons.

Some viral STDs stay with you for life, such as herpes and HIV. Others, such as hepatitis B and human papillomavirus (HPV), can be prevented with vaccines but cannot be cured. It’s also possible for the immune system to defeat hepatitis B virus and HPV — but in some cases, these viruses are able to settle in for the long haul, causing chronic infections that can endure for life and even lead to cancer.


Left untreated, syphilis can kill, and gonorrhea can cause infertility.


Non-viral STDs, like chlamydia and gonorrhea, can be cured. However, they usually don’t have symptoms, or symptoms can come and go, making it seem like an infection went away when it actually didn’t. You can’t know your STD status without getting tested, and you can’t self-diagnose an STD based on symptoms and then assume the infection went away when symptoms subside. Getting tested can uncover a problem and clear the way for treatment.

Nonetheless, people want to know if an STD can go away by itself — but there aren’t many studies on the “natural history” of curable STDs like gonorrhea, chlamydia, and trichomoniasis. Studying the natural course of a curable infection would require that scientists put their subjects at risk of the dangers of long-term infection, and no ethics board would approve such an experiment. Continue reading

STD Awareness: Mycoplasma genitalium

Image of Mycoplasma genitalium adapted from American Society for Microbiology.

“I’m not small, I’m just streamlined!” Image of Mycoplasma genitalium adapted from American Society for Microbiology.

In November and December of last year, headlines touting a “new” STD made an ever-so-minor flurry across the Internet. CNN referred to it as “mycoplasma genitalium, or MG” — Mycoplasma genitalium is the name of the teardrop-shaped bacteria that can cause several diseases in the urinary or reproductive tracts, such as urethritis and pelvic inflammatory disease.

M. genitalium is the smallest living organism known to science, having “devolved” from more complex organisms — but that doesn’t mean it can’t pack a punch! While these bacteria have surely been around for millennia, we only discovered them in the 1980s. Since then, we’ve known that M. genitalium fits the profile of a sexually transmitted pathogen — the only reason it made the news last year was that a team of British researchers published further evidence that this bug is indeed sexually transmitted and capable of causing disease.


Genital mycoplasmas can be cured — but a doctor needs to know what she’s looking for in order to prescribe the correct antibiotic!


An infection with M. genitalium could more generally be called a “genital mycoplasma.” The term “genital mycoplasmas” refers to a category of several different species of sexually transmitted bacteria, most notably Mycoplasma genitalium, but also less common species, such as Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. M. genitalium is considered an “emerging pathogen,” because it is only over the past couple of decades that technology has allowed us to study these bacteria, along with other genital mycoplasmas.

Risk factors for infection include multiple sexual partners and not using condoms during sex. It is thought that most people with an M. genitalium infection don’t have immediate symptoms — 94 percent of infected men and 56 percent of infected women won’t notice anything amiss. That doesn’t mean it can’t do damage. Continue reading

Is Douching Safe?

This vintage douche ad claims that its product is “safe to delicate tissues” and “non-poisonous.”

Douching is the practice of squirting a liquid, called a douche, into the vagina. Many people believe it helps keep the vagina clean and odor-free, and some are under the impression that it helps prevent pregnancy and sexually transmitted diseases. An estimated 25 percent of American women 15 to 44 years old douche regularly. But just because douching is widespread doesn’t mean it’s safe; indeed, there are two possible mechanisms by which douching might be harmful.

First, douching might alter the pH of the vagina, changing its ecosystem. You might not think of a vagina as an “ecosystem,” but the bacteria and other microscopic organisms that live there sure do — and altering their habitat can harm the beneficial microbes that live there, opening the door for disease-causing microbes to take over the territory. Frequent douching can result in the vagina’s normal microbial population having difficulty reestablishing its population.


Douching increases risk for infections and fertility problems, and has no proven medical benefits.


Second, a douche’s upward flow might give pathogens a “free ride” into the depths of the reproductive tract, granting them access to areas that might have been difficult for them to reach otherwise. In this manner, an infection might spread from the lower reproductive tract to the upper reproductive tract. Douching might be an even bigger risk for female adolescents, whose reproductive anatomy is not fully formed, leaving them more vulnerable to pathogens.

While douching is not guaranteed to harm you, there is no evidence that it is beneficial in any way. Establishing causation between douching and the problems that are associated with it is trickier — does douching cause these problems, or do people who douche also tend to engage in other behaviors that increase risk? So far, the best evidence indicates that douching is correlated with a number of diseases and other problems, including sexually transmitted diseases (STDs), bacterial vaginosis, pelvic inflammatory disease, fertility and pregnancy complications, and more. Continue reading

Over 90 Percent of What Planned Parenthood Does, Part 22: Expedited Partner Therapy for Chlamydia

200373577-001Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

So, you got chlamydia. It happens. In fact, it happens to an estimated 2.86 million Americans every year, and is the most common bacterial sexually transmitted disease (STD) in the country.


After testing positive for chlamydia, you can receive extra antibiotics to hand-deliver to your partner.


Your infection didn’t come out of thin air — you got it from somewhere. Maybe you have a new sex partner who wasn’t tested and treated for any STDs before you got together. Perhaps you’re in a non-monogamous relationship. You also could have had it for a while before you found out about it, during which time a partner might have unknowingly caught it from you. One reason chlamydia can spread so easily — by vaginal, anal, or oral sex — is because it usually doesn’t come with symptoms. Amazingly, most people with chlamydia don’t know they have it unless they take an STD test to screen for it.

But the fact remains: You got chlamydia. Now what? Continue reading