Remember that time when you didn’t take your antibiotics as prescribed?
Remember how your doctor told you that by not adhering to their intended use, you could risk your infection developing resistance to antibiotics?
Well, this week, we want to share with you the story of antibiotic resistant gonorrhea, an STD, which is showing an exceptional ability in mutating out of the reach of current FDA approved antibiotic treatments.
If you’re already familiar with gonorrhea, skip down to Part VI.
First, let’s review what gonorrhea is and why young people are at an increased risk for becoming infected with this STD.
Gonorrhea is one of the most common STDs in the US. There are approximately 820,000 new infections of gonorrhea per year, 70% of which are diagnosed in 15-24 year olds.
Part I. What makes 15-24 year olds so susceptible to gonorrhea infections?
Part of it has to do with biology. Young women’s bodies are actually more susceptible to STDs. Young people are also more likely to have multiple sex partners, which inherently increases their likelihood of obtaining an STD. (Probabilty theory, ayyyy!)
But another part has to do with our health care infrastructure. This age group is more likely to be on their parent’s health insurance, and may not want their parents to see a bill for an STD screen. They may also not have health insurance, and thus not have the ability to pay for an STD test.
Additionally, current STD screening practices are insufficient for this age group. There are not enough opportunities for young people to get tested. For example, while most primary care offices have STD screens available, they may not explicitly ask someone if they want an STD panel once the patient says they are sexually active. And that’s also another part of it: it may be hard for some young people to discuss their own sexual behaviors with their childhood doctors. Doctors may not be able to offer STD testing, since they aren’t aware their patient is sexually active.
Part II. There are more people who don’t know they have gonorrhea than people who do
Among this age group, only 200,000 out of the total estimated 570,000 who have gonorrhea are diagnosed each year. The rest have no clue that they have gonorrhea. That’s approximately 370,000 people aged 15-24 in the United States who are most likely sexually active, and have no idea that they have gonorrhea.
How are so many young people not aware that they are infected with gonorrhea? Wouldn’t you be able to tell if you had an STD?
The truth is that you can’t always tell if you have an STD.
Part III. Common Symptoms of Gonorrhea
Gonorrhea often has no symptoms. This is more common in women than men, however both genders have a pretty high percentage showing no symptoms. Gonorrhea can be spread by and infected in genitalia, the rectum, and the throat. This means you can obtain in from vaginal, anal, and oral sex, as well as during birth. Quick note here: there doesn’t have to be ejaculation for gonorrhea to spread from one person to another.
Some common symptoms for men (if you do have symptoms) are burning while urinating, white, yellow, or green discharge from the penis, and painful or swollen testicles, although this is less common.
Common symptoms for women (although, remember, it’s more common than not for women not to have symptoms) are burning while urinating, increased vaginal discharge, anal itching, and soreness, bleeding, or painful bowel movements.
Part IV. What happens if you don’t take care of a gonorrhea infection promptly?
So what happens to your body when you let gonorrhea go untreated? Untreated gonorrhea can lead to pelvic inflammatory disease. This can create long-term pelvic/abdominal pain and create blocking of the fallopian tubes, which can lead to an ectopic pregnancy (or a pregnancy outside of the uterus), and infertility. Additionally, being infected with gonorrhea increases your chances of becoming infected with HIV.
Part V. What are the current recommendations for getting STD tested?
Above, we have explained what happens if you don’t treat a gonorrhea infection. We also know that we may not show symptoms if we are infected with gonorrhea. So the obvious next question we may ask ourselves, is:
“I’m sexually active. What should I do to make sure I know about an STI and get treated?”
The answer is simpler than it sounds. Get tested. Between partners. And often. The only way to get treatment is to know, and the only way to know is to get tested.
Currently, the CDC recommends yearly STD screenings for people under the age of 25. If you’re sexually active, talk to your provider about your risk factors and what you can do to keep yourself safe.
And treatment is pretty simple- just a regiment of antibiotics. You’d get swabbed at the doctor’s office or STD clinic, they’d run the test, and then you would come back to get your results and your antibiotics.
Part VI: Antibiotic-resistant gonorrhea
We’ve talked about how gonorrhea in itself can be harmful if you don’t get treated. Getting people tested and into treatment is already a significant problem for the medical community.
However, there is an emerging threat that presently faces scientists, practioners, and patients alike, which is that increasing numbers of high-income countries, whom generally have the best infectious disease surveillance systems, have reported drug resistant strains of gonorrhea.
In 2009, the World Health Organization’s surveillance program called the Gonococcal Antimicrobial Surveillance Program (WHO GASP for short) showed that 97% of reporting countries found drug resistant strains of gonorrhea, with an increase in resistance to ciprofloxacin and azithromycin (two well used antibiotic treatments for gonorrhea), and an emergence of resistance to the current last-resort treatment oral cefixime and injectable ceftriaxone. They’ve generally seen more trends of resistance in older and cheaper antibiotics.
And this is not to mention that there’s not very high quality data for low-income countries. However, gonorrhea is more common in low-income countries mostly because they have fewer resources in place to diagnose and report untreatable infections. So the percentage of drug resistant strains of gonorrhea may be higher than what we currently are aware of.
This means that for some people, NO known antibiotics can treat their strain of gonorrhea, and that these people will live with chronic gonorrhea (the effects of which we discussed in part IV.) until a new antibiotic can be developed.
And what if this strain is passed on to someone else? What if it spreads to a large amount of people? What will the economic burden of this be, and how would that affect health care infrastructures around the world?
Part VII Why is this happening right now and what can we do to prevent the spread of gonorrhea?
Experts speculate that decreasing condom use, increased urbanization and travel, poor infection detection rates, and inadequate or failed treatment may be to blame for the rising rates of antibiotic resistance in gonorrhea.
There are some things we can do to try to prevent the spread of gonorrhea. For example, safe sex: use condoms consistently and correctly. Also, by providing information, education and communication, we can help people practice safe sex, recognize symptoms of STDs, and increase the likelihood that one would seek out care.
Recently, the medical community has changed the way they prescribe antibiotics for gonorrhea, because of the increased numbers of strains showing antibiotic resistance. Instead of prescribing various antibiotics in multiple ways, the CDC has issued a recommendation for the use of only two antibiotics, which have less resistance than some of the older antibiotics. Their hopes are that this rigid prescribing practice will keep resistance at bay, and that these antibiotics will continue to successfully treat gonorrhea for future years to come.
However, we still face many barriers to protecting ourselves and our fellow humans. The lack of public awareness and training of health workers about STDs, and the stigma associated with STD’s is at the foremost of the problems trying to reach people and connect them with care. Concurrently, there is no rapid test for gonorrhea, which makes it more difficult to obtain quick results.
You can tackle these issues yourself by having open conversations with your friends and family members, reduce stigma, get tested, and practice safe sex.
You only know if you get tested.