A Little Infection, or a Superbug?

By Brett Edward Stout

Originally published on Advocate.com April 19 2012 1:00 AM ET

Gonorrhea is often viewed as an easily curable inconvenience that sometimes comes with being sexually active, but that may soon change. While antibiotics have effectively treated gonorrhea for decades, some strains of the bacterium are mutating to form a resistance to each new medication used against it, opening the door for it to become an incurable superbug. A 2009-2010 study by the Centers for Disease Control and Prevention found five times as many cases of gonorrhea with some degree of resistance than there were in the 2000-2006 period, requiring higher-than-normal drug doses to cure. The number is still small, but with no new antibiotics in the pipeline, there is cause for alarm.

Gonorrhea is one of the most common sexually transmitted infections, with more than 300,000 reported cases annually. Therefore, an untreatable strain of the highly contagious STI could have serious consequences. The aforementioned CDC report indicated that 29% of cases with elevated resistance were among men who have sex with men. Additionally, gonorrhea infections among men who have sex with men tend to go undiagnosed due to a general avoidance of extra-genital testing (rectal and throat swabs), amplifying the chances of transmission.

Because gonorrhea has thus far been so easily treatable, often little attention is paid to the long-term health effects of prolonged infection, which can include genital pain, infertility, permanent joint damage, and even death. Also, the infection significantly increases the likelihood of a person contracting HIV or infecting a partner with it, even if the HIV-positive person has an undetectable viral load.

CDC officials say the only effective treatment for gonorrhea is the class of antibiotics known as cephalosporins, combined with another antibiotic, either azithromycin or doxycycline. Strains of gonorrhea with heightened cephalosporin resistance are not yet at superbug levels, but with such resistance becoming more common, it may be necessary to find new treatments. While there are possibilities of treating infection with bacteriophage (a virus that infects bacteria) and gene therapy, those solutions will take time to develop. The current treatments are still effective at eradicating even the more resistant strains from the body, but the higher doses needed to do so can cause complications.

Condoms and dental dams, when used properly, remain the best defense against nearly all STIs. Sexually active people should follow safer sex guidelines and have regular tests for the full spectrum of STIs.