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STD Awareness: An Update on Antibiotic-Resistant Gonorrhea

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Last year, we shared the fascinating and frightening story of the emergence of increasingly antibiotic-resistant gonorrhea, an STD caused by the gonococci bacteria. The sexually transmitted scourge, which we only so recently reined in with the development of antibiotics, has been performing some genetic gymnastics to defeat almost every drug we’ve thrown at it. We douse it with certain drugs, and the bacterium literally spits them back out at us, and it inactivates other drugs by snapping the active molecules in half. Sulfa drugs, penicillins, tetracyclines, fluoroquinolones — they all make a gonococcus heave a bored sigh. Luckily, cephalosporins were still an effective treatment, but recently there have been reports of stubborn gonorrhea infections caused by the latest and greatest (and some might say most hated) strain of gonococci.

The bacteria that cause gonorrhea continue to evolve, right under our noses!

Well, the story isn’t over — just like the bacteria that cause gonorrhea, the tale is rapidly evolving. The latest class of antibiotics that the gonococci are chipping away at is the cephalosporin family, which includes several chemically related drugs that work in similar ways — and that can likewise be defeated by microbes in similar ways. Cephalosporin-resistant gonorrhea was first reported in Japan and documented in a few European countries. The Japanese case that inspired the New England Journal of Medicine to declare last year that it was “time to sound the alarm” was an oral gonorrhea infection that was resistant to one member of the cephalosporin family: ceftriaxone.

Earlier this month, the prestigious medical journal JAMA reported the first North American sightings of gonorrhea that failed treatment with another cephalosporin: cefixime. Yeah, I know, you’d rather hear about Big Foot or UFO sightings, not evidence that something as real and unmythical as Gonorrhea 5.0 has landed in your back yard. Luckily, there’s plenty you can do to protect yourself from it, and we’ll tell you all about it toward the end of this article. (Spoiler alert: It involves using condoms!) Continue reading →

STD Awareness: Antibiotic-Resistant Gonorrhea

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Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Writing about sexually transmitted diseases (STDs), one must walk the line between warning readers of risks and engaging in full-fledged alarmism. So it’s a bit disconcerting that researchers writing in the New England Journal of Medicine last month declared that it’s “time to sound the alarm”: The emergence of completely antibiotic-resistant gonorrhea is becoming more of a realistic threat and less of a theoretical possibility. The bacteria that cause gonorrhea are evolving faster than we can develop effective antibiotics against them, and a return to the era of untreatable gonorrhea could see a rise in the particularly nasty complications that arise from a long-term gonorrheal infection, such as pelvic inflammatory disease and epididymitis.

There are genes that confer resistance to every single antibiotic we use to cure gonorrhea. If they all combine within one organism, we might have a superbug on our hands.

Neisseria gonorrhoeae is a species of tricky bacteria that cause gonorrhea, which can infect the mouth, throat, rectum, urethra, cervix, and even eyes. These bacteria have vexed us for thousands of years, having evolved many strategies for entrenching themselves in our bodies. They can alter the proteins that adorn their surfaces, rendering our immune systems incapable of recognizing them. They can form colonies in which they work together to manipulate our cell surfaces with their retracting appendages until they’re allowed entry inside, where they can surreptitiously multiply.

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that has acquired resistance to methicillin, as well as pretty much every other antibiotic to boot. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.

Why are we talking about MRSA in a post about STDs? It’s not just because MRSA has apparently found a way to be transmitted sexually, but also because it helps make the concept of antibiotic-resistant gonorrhea more accessible. It wasn’t until less than a century ago that we finally developed a magic-bullet treatment for gonorrhea, and for a handful of decades it was quickly and easily treated with a dose of penicillin. Enter evolution by natural selection. Continue reading →

STD Awareness: Gonorrhea

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Neisseria gonorrhoeae, the bacteria species that causes gonorrhea, is pictured here in a photograph taken with a scanning electron microscope. Projecting from the organism’s surface are many pili, powerful appendages that enable the bacteria to adhere to human cells. Image from the National Institute of Biomedical Imaging and Bioengineering.

Neisseria gonorrhoeae, the bacteria species that causes gonorrhea, is pictured here in a photograph taken with a scanning electron microscope. Projecting from the organism’s surface are many pili, powerful appendages that enable the bacteria to adhere to human cells. Image from the National Institute of Biomedical Imaging and Bioengineering.

April is STD Awareness Month, but this blog has sought to increase your awareness of sexually transmitted diseases on a monthly basis. So far in 2011 we’ve pointed the spotlight at human papillomavirus, barrier methods, and herpes. This month’s installment will focus on gonorrhea, colloquially known as “the clap,” a common sexually transmitted disease caused by sneaky bacteria called Neisseria gonorrhoeae. It is spread by vaginal, anal, and oral sex, and can infect certain cells in the throat, mouth, rectum, urethra, or cervix. It can also be transmitted manually to infect the eye. If you are sexually active, you can reduce risk of transmission by consistently and correctly using latex barriers such as condoms and dental dams.

Four out of five females infected with gonorrhea do not experience symptoms – males, however, usually do, but they can be mild and therefore easy to overlook. Symptoms can appear within a month, and might include painful or frequent urination, vaginal or penile discharge, painful bowel movements, itching, or sore throat. Additionally, females can experience abdominal pain, fever, irregular menstruation, or bleeding between periods. In pregnant women, untreated gonorrhea infections can lead to complications such as premature labor or stillbirth. The infection can also be passed from mother to infant during delivery.  Continue reading →