STD Awareness: Gonorrhea, Women, and the Pre-Antibiotic Era

Penicillin, the first cure for gonorrhea, was developed for mass production in the 1940s.

Penicillin, the first reliable cure for gonorrhea, was mass produced in the 1940s.

It’s Women’s History Month, a time to reflect on the achievements of women worldwide — like Margaret Sanger, Rosalind Franklin, and Florence Nightingale, or contemporary heroes like Wangari Maathai. But it may also be a time to examine some of the sadder aspects of womanhood, including the increased burden gonorrhea imposes on women. While gonorrhea is no picnic for anyone, it wreaks the most havoc in female reproductive tracts. In fact, before antibiotics, gonorrhea was a leading cause of infertility — one 19th century physician attributed 90 percent of female infertility to gonorrhea. Not only that, but the effects of gonorrhea could seriously reduce a woman’s overall quality of life.


With gonorrhea becoming more resistant to antibiotics, the CDC warns of a return to the pre-antibiotic era.


Gonorrhea is described by written records dating back hundreds of years B.C. Ancient Greeks treated it with cold baths, massage, “cooling” foods, and vinegar. In the Middle Ages, Persians might have recommended sleeping in a cool bed with a metal plate over the groin. A bit to the west, Arabs tried to cure gonorrhea with injections of vinegar into the urethra. Kings of medieval England might have had their gonorrhea treated with injections of breast milk, almond milk, sugar, and violet oil.

Although gonorrhea is as ancient an STD as they come, because women rarely have symptoms while men usually do, for much of history it was mostly discussed in terms of men. The name gonorrhea itself derives from the ancient Greek words for “seed flow” — gonorrhea was thought to be characterized by the leakage of semen from the penis. This confusion inspired many misguided notions throughout the millennia, such as the idea that almost all women carried gonorrhea and transmitted it to their unwitting male partners. Continue reading

STD Awareness: Chlamydia trachomatis

A colony of C. trachomatis (colored green) is nestled inside a human cell. Image: V. Brinkmann, Max Planck Institute for Infection Biology

A colony of C. trachomatis (colored green) is nestled inside a human cell. Image: V. Brinkmann, Max Planck Institute for Infection Biology

In the microscopic world of germs, organisms called Chlamydiae are dwarfed by their fellow bacteria. An E. coli bacterium can hang out with 100,000 of its closest friends on the head of a pin, but Chlamydiae are smaller still. Infectious particles are about one-tenth the length of an E. coli, rivaling the size of a large virus. And, just like a virus, Chlamydiae can still pack quite a punch, proving that sometimes, not-so-good things can come in small packages.

There are many types of Chlamydiae bacteria, but one species, Chlamydia trachomatis, is responsible for not one, but two sexually transmitted diseases (STDs) in humans: chlamydia and lymphogranuloma venereum (LGV). (Humans aren’t the only ones affected by sexually transmitted Chlamydiae. A different species, Chlamydia pecorum, is devastating wild koalas in Australia, which has got to be one of the biggest bummers ever.)


Chlamydia is a case study for the importance of safer sex and regular STD testing.


Chlamydia is one of the most common STDs in the United States — there were almost 1.5 million diagnoses in 2011 alone, but experts estimate that there were around another 1.5 million cases of chlamydia that went undiagnosed. How can this be? Chlamydia is often a “silent” infection, meaning that symptoms are rare, allowing people to harbor these bacteria without even knowing it. (When symptoms do occur, they might include swelling in the genital region; vaginal, cervical, or penile discharge; or painful urination.)

It might seem like a small mercy that this common infection is unlikely to torture us with harrowing symptoms — but, in actuality, those of us who have to deal with discharge or burning urination should try to appreciate the heads up: Left untreated, chlamydia can cause serious complications. When it spreads along the female reproductive tract, it can cause pelvic inflammatory disease, which can severely compromise fertility and cause chronic pain. Rarely, in a male reproductive tract, it can cause epididymitis, which can also spell bad news for future fertility. Continue reading

STD Awareness: The Latest on Gonorrhea

Neisseria gonorrhoeae, the bacterium that gangs up on your body to give it gonorrhea. Image: CDC

Neisseria gonorrhoeae, the bacterium that gangs up on your body to give it gonorrhea. Image: CDC

Gonorrhea is that guy with the funny name who’s always up to something new and mischievous. Last year, the New England Journal of Medicine declared that it’s “time to sound the alarm” in response to emerging strains of gonorrhea that are increasingly resistant to antibiotics. Then, earlier this year, the medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with cefixime, one of the last drugs we have in our anti-gonorrhea arsenal. It’s a great time to be a gonococcus — the type of bacteria that causes gonorrhea — but the humans they infect probably don’t see it that way.

Last month, this bad boy rose to the top of the Most Wanted list when the Centers for Disease Control and Prevention proclaimed antibiotic-resistant gonorrhea an “urgent threat” — the highest threat level, which gonococci share with only two other bacteria types. To give you some context, the much more famous superbug MRSA was categorized as a “serious” threat, one notch below “urgent.”


Antibiotic-resistant gonorrhea is an “urgent” threat; meanwhile, researchers develop a gonorrhea vaccine that works — on mice.


Antibiotic-resistant gonorrhea is especially insidious for two reasons. One, gonorrhea often doesn’t have symptoms, which allows it to jump from one sexual partner to another, the hosts often none the wiser. Two, unless health care providers actually test the bug’s DNA, they have no way of knowing whether or not they’re dealing with a drug-resistant strain. This opens up the possibility for treatment failure — and for the antibiotic-resistant bacteria to be further propagated into the community.

The CDC estimates that the United States sees 246,000 cases of antibiotic-resistant gonorrhea infections annually — that’s about 30 percent of all gonorrhea infections in the country. For now, we seem to be able to cure them with higher doses or different combinations of drugs. So why does antibiotic-resistant gonorrhea deserve the “urgent” designation? While gonorrhea isn’t associated with a body count — unlike other drug-resistant pathogens, which collectively kill at least 23,000 Americans a year — it can have terrible consequences. Gonorrhea can cause pelvic inflammatory disease (PID) when it advances up the female reproductive tract, and epididymitis when it invades the male reproductive tract; both conditions can cause infertility. Also, gonorrhea infections make us more vulnerable to HIV. The CDC estimates that if the most resistant gonorrhea strain gains ground over the next decade, the country could see an additional 75,000 cases of PID, 15,000 cases of epididymitis, and 222 HIV infections, costing us $235 million. Continue reading

STD Awareness: Will Gonorrhea Be Worse Than AIDS?

A scanning electron micrograph of a colony of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: Portland State University

A scanning electron micrograph of a colony of Neisseria gonorrhoeae, the bacteria that cause gonorrhea. Image: Portland State University

If you’ve been reading the news lately, you might have noticed an odd piece of reportage from CNBC, in which a naturopath claimed that antibiotic-resistant gonorrhea “might be a lot worse than AIDS” and might cause cases of sepsis that could kill “in a matter of days.” This quotation, uttered by a single naturopath, was then exaggerated in sources such as the United Kingdom’s Daily Mail, which ran the headline “Doctors warn that antibiotic-resistant strain of gonorrhea could be ‘worse than AIDS.’” In fact, the only person making this claim was one naturopath, not a doctor, and certainly not plural “doctors.”

There’s a lot to unpack here. First is the alarmism in the original CNBC article, and its dependence on an unreliable source. Second is the issue of antibiotic-resistant gonorrhea itself, which is a very serious public health problem. Thirdly, let’s look at the naturopath’s claim, which is that antibiotic-resistant gonorrhea could unleash a plague worse than AIDS and kill its victims in a matter of days.


Claims that antibiotic-resistant gonorrhea will be “worse than AIDS” are greatly exaggerated.


Alan Christianson, the naturopath behind the hyperbolic claims of super-virulent gonorrhea, does not seem to be an actual expert in infectious disease (his website lists “natural endocrinology” and “male menopause” among his specialties), nor is he a medical doctor. The article identifies him as a “doctor of naturopathic medicine,” but what does that mean?

Naturopaths are not medical doctors, and degrees in naturopathic medicine aren’t awarded by institutions accredited by the Association of Medical Colleges, the body that accredits medical schools. Naturopathy is a philosophy that is not generally supported by scientific evidence, but rather is based in “a belief in the healing power of nature,” according to the National Center for Complementary and Alternative Medicine. It was developed in the 1800s and today encompasses many modalities of alternative medicine, including homeopathy and herbalism. For these reasons, it is odd that a journalist quoted a naturopath on the potential of antibiotic-resistant gonorrhea rather than someone more qualified, such as a microbiologist or epidemiologist. Continue reading

STD Awareness: “Can STDs Lead to Infertility?”

Being diagnosed with a sexually transmitted disease (STD) can be upsetting. Some take it as evidence that they’ve been cheated on; others wonder if they can ever have sex again. Some people who have long dreamed of having children might worry about what impact, if any, their STD could have on future fertility. The bad news is that certain STDs can make it difficult or impossible to have children. But the good news is that STDs are avoidable — and regular STD screening can ensure that infections are caught and treated before they have time to do damage.


It’s common for STDs not to have symptoms, and infections can cause tissue damage — unbeknownst to you!


Fertility can be impacted in several ways. The ability to become pregnant and bear children can be affected by a condition called pelvic inflammatory disease, which is usually caused by untreated gonorrhea or chlamydia infections. If you have a cervix, an infection with a high-risk strain of HPV can require invasive treatment, which in some cases might affect the ability to carry a pregnancy. If you have a penis, an untreated STD might lead to epididymitis, which in extreme cases can cause infertility.

Pelvic Inflammatory Disease (PID)

Many sexually transmitted infections are localized; for example, the bacteria that cause gonorrhea usually just hang out on the cervix. But untreated infections can spread on their own, and bacteria can also hitch a ride on sperm or the upward flow of a douche, which can take them into the cervix, through the uterus, down the fallopian tubes, and to the ovaries. At any of these locations, microbes can stake claim on your reproductive real estate, establishing colonies deep in your reproductive system. As these colonies grow, the bacterial infections become more widespread, and can cause scarring and other tissue damage. To keep these interlopers from getting through the front door, sexually active people can use barrier methods, such as latex condoms — especially with spermicides. There’s no need to host an open house for sexually transmitted bacteria in your uterus. Continue reading

STDs 101: An Introduction to Sexually Transmitted Diseases

Coupons for STD-screening discounts in April 2014 are available here.

It’s April, which for Arizonans means a gradual increase in temperature as we head toward summer. But at Planned Parenthood Arizona it also means that it’s time to focus on sexually transmitted diseases (STDs) in observance of STD Awareness Month. While we regularly provide information about sexual health with our monthly STD Awareness series, April is the time of year to fix the spotlight on sexually transmissible microbes and the infections they cause. April is also the time of year when Planned Parenthood Arizona offers coupons for discounted STD screening, so if you’ve been putting it off, now’s the time!

Symptoms of Sexually Transmitted Diseases

First, some basic facts. STDs can be transmitted through all sexual activities — vaginal, anal, or oral sex, as well as activities involving skin-to-skin contact. STDs are most commonly caused by viruses or bacteria, though they can be caused by other agents as well, including animals! Each STD is unique, with unique symptoms, but common symptoms include:

  • rashes, open sores, blisters, or warts in the genital area
  • swelling or tenderness
  • pus, bleeding, odor, or abnormal discharge
  • itching in the genital region
  • burning sensation during urination

It’s best not to focus too closely on symptoms, though – most people with STDs actually don’t experience any symptoms whatsoever! As they say in the biz, “The most common symptom of an STD is … no symptom.” For example, most people with herpes either have no symptoms or have mild symptoms that go unnoticed. Ten percent of males and 80 percent of females with gonorrhea don’t experience symptoms, and most people with chlamydia are asymptomatic. And HIV symptoms usually take a decade to show up. If you are, or have been, sexually active, you can’t assume that the absence of symptoms means you’re in the clear. To know for sure if you have an STD, the best thing you can do is to get yourself tested. Continue reading

STD Awareness: Bacterial Vaginosis and Chancroid

Sexually transmitted diseases can be caused by viruses, bacteria, protozoans, and even animals. Bacterial vaginosis and chancroid are both infections caused by bacteria, which means that they can be treated with antibiotics. While bacterial vaginosis only affects people with vaginas, chancroid disproportionately affects people with penises. You can seek diagnosis and treatment for bacterial vaginosis and chancroid at a Planned Parenthood health center, as well as health clinics, private health-care providers, and health departments.

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial Vaginosis
Bacterial vaginosis seems to be most commonly caused by the bacteria species Gardnerella vaginalis. Scientists aren’t quite sure how this infection is caused, but risk seems to correlate with a change in sexual partners, having multiple sexual partners, douching, or using an intrauterine device; it can also occur in females who have never been sexually active. It is more common in pregnant women. There is no counterpart to this infection in males, although G. vaginalis can be found in their urethras; this raises the possibility that bacterial vaginosis can be sexually transmitted, in which case it could be directly transmitted between two females or indirectly transmitted from one female to another via a male.

Bacterial vaginosis seems to result from an imbalance in the vaginal flora (“flora” is a somewhat fanciful term for the bacteria that live in your body; under normal circumstances they are harmless and even beneficial). Vaginas usually are habitat to a population of bacteria called Lactobacillus, which produce hydrogen peroxide as a byproduct. When the number of Lactobacillus declines, G. vaginalis is able to move in on Lactobacillus’ old territory. The decrease in Lactobacillus and increase in G. vaginalis leads to a rise in the vagina’s pH. The new vaginal environment is less acidic and more alkaline; a vaginal pH of more than 4.5 is one criterion for the diagnosis of bacterial vaginosis. Another symptom includes a vaginal discharge that may smell somewhat fishy. There might also be genital itching or pain during urination. It is also possible not to have symptoms. Continue reading