Gonorrhea Resistance to Antibiotics Could Become a Public Health Crisis

Until last week, you didn’t hear much anymore about gonorrhea, a sexually transmitted infection formerly known as a “venereal disease.” It’s back in the limelight because the news is all bad. The Centers for Disease Control and Prevention says that gonorrhea is getting dangerously close to being untreatable.

The problem, as outlined by NPR, is that antibiotic options to treat gonorrhea are becoming increasingly limited. Basically, there’s only one antibiotic that can still eradicate the infection.

We’ve written before about the health threats of antibiotic resistance.

About 700,000 Americans get gonorrhea every year. If it’s left untreated, the infection can cause infertility and life-threatening ectopic pregnancies.

“Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline and doxycycline – very commonly used drugs,” Jonathan Zenilman, who studies infectious diseases at Johns Hopkins, told NPR. But one by one, each of those antibiotics – and almost every new one developed since -stopped working. One reason is that the bacterium that causes gonorrhea can mutate quickly to defend itself, Zenilman said.

Another reason these drugs don’t work anymore is that they’re overprescribed and overused. That enables the bugs to “learn” how to survive against them; that is, they mutate until they become resistant. When antibiotics intended to treat gonorrhea also are used to treat urinary tract, upper respiratory and other kinds of infections, the germs are just given that much more opportunity to develop resistance. Also, when patients fail to take the full course of an antibiotic-that is, they stop taking the drug when their symptoms improve even though they’re supposed to take every pill in the prescription-bacterial resistance improves.

Doctors recently had only two antibiotics that still worked well against gonorrhea – cefixime and ceftriaxone. But last week, the CDC announced that in the U.S., gonorrhea had started to become resistant to cefixime.

“We’re basically down to one drug … as the most effective treatment for gonorrhea,” one federal official said.

Even worse, cefixime and ceftriaxone are in the same class of antibiotics. So it’s only a matter of time before ceftriaxone loses its punch, too. “The big worry is that we potentially could have untreatable gonorrhea in the United States,” the official said. It has happened in other countries.

The CDC said doctors should stop using cefixime immediately, and has issued new guidelines for treating gonorrhea.

They know it won’t be easy: Ceftriaxone is an injection, not a pill. And it should be given along with at least one other antibiotic.

Even so, “it’s only a matter of time based on the history of this organism until resistance does develop,” the CDC official said.

In a follow-up story, NPR discussed the scope of the antibiotic-resistance problem with Dr. Arjun Srinivasan, an epidemiologist with the CDC. He made clear that the responsibility to stop overusing these drugs lies with both patients and doctors.

“As patients,” he said, “we need to be informed consumers. We should never demand antibiotics when our doctors don’t think we need them. And as medical providers, we need to consider very carefully when we are writing a prescription for an antibiotic. We need to make sure that the patient actually needs the antibiotic.

“And if they do, we need to make sure that we’re up on the latest information so we’re giving exactly the right drug for exactly the right dose for exactly the right time.”

Srinivasan reviewed the need for hospitals and medical staff to practice infection control.

One of the major concerns with antibiotic resistance is the drugs’ use for livestock, which we discussed earlier this year, and how it promotes resistance via the food chain. Srinivasan, as a federal official, danced around that one, and someone called him on it in the story’s website comments:

“Dr. Srinivasin conveniently dodged the question about antibiotics in food animals given as growth promoters. It’s unfortunate he did so; I assume he’s not up on the issue. It’s huge, probably more important than medical use.”

The development of new drugs is troubled, too, because-surprise!-the profit motive isn’t there. As Srinivasin said, “It’s not simple to develop new antibiotics. Another thing that you hear from drug companies is, of course, that these are drugs for which there is not a substantial profit margin. And as drug companies, they have shareholders to whom they are responsible and they have a duty to try and develop drugs that are going to make money for their shareholders.”

He suggests that this problem can be addressed through collaboration between government and Big Pharma.

Good luck with that.

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