By Daniel Peixoto Irby
UCB-UCSF Joint Medical Program, MS Candidate 2013, MD Candidate 2015
[caption id="attachment_1007" align="alignleft" width="178"]Image credit: Atticpaper.com Image credit: Atticpaper.com[/caption]

When I was a kid, my mother took me to visit her family in Brazil in years when we had time. There, I got into all sorts of scrapes, trips, and cuts, as kids do. When that happened, my grandmother, who grew up on a farm, would pin me down and paint this stinging stuff onto the affected area. Mertiolate, it was called there. I still remember its harsh-sounding name, its acrid smell, the sting, and the cooling after-sensation when my grandma would blow on my cut. Maybe you had a similar experience-- but this is probably not where we want to go back to if one of us or one of our friends, god forbid, were to come down with gonorrhea. Recent scientific reports indicate that it’s just a matter of time, unless new antibiotics are discovered that slow these dread bugs. Back before antibiotics, gonorrhea and many other infections were treated with things like mercurochrome-- I think we would all prefer to keep that a historical footnote.

The Age of Antibiotics

Antibiotics revolutionized the treatment of gonorrhea in the 1930s, but by the 1940s the sulfa class of antibiotics were increasingly ineffectual. This would turn out to be a harbinger of things to come. At the time, penicillin was quick to stem the tide, until the mid-1970s, when the critters cracked that nut. No sweat: we had fluoroquinolones. Some intrepid gonorrhea evolved into the oddly-named QRNG: Check (as in chess). (By now we’re resigned to the dismaying arc of the story.) In 2010, we were down to the futuristic-sounding cephalosporins. Guess what? Well, it’s not quite to the point where nothing works. But there are some disturbing trends, and some facts about which you should be aware. N. gonorrhoeae resistance to cephalosporins first emerged in East Asia in the early 2000s, then France (2009), Spain (2010), and recently CDC surveillance has indicated that cephalosporins are not working as well as they used to against gonorrhea in the US. This emergence has tracked along where previous QRNG emerged: Hawaii, California, and the rest of the western US, and especially in the populations of gay, bisexual, and other men who have sex with men. The idea to go back to some of the older antibiotics that were shelved in the fight against gonorrhea has been batted around, but resistance rates have been remeasured by CDC surveillance (who ever said the government never did anything for you?) and were found to be between 12 and 24 percent for various older antibiotics. This means that the days of going to a doctor and getting effective antibiotics on the spot for a gonorrhea infection are likely numbered. Some other facts to know are that effective treatment of gonorrhea now relies increasingly on the ability of the treating facility to have access to a laboratory that can do the appropriate cultures (gonorrhea is still cultured, as there are not yet any widely-available fancy tests like those used in diagnosing HIV). This is important to keep in mind if you or someone you know is seeking treatment for gonorrhea. A key reason for this is that research has suggested that antibiotic-resistant strains of gonorrhea, which we know are on the rise, will cause worse infections if left untreated-- that is, they are probably both harder to treat and worse for the infected individual.

Gohorrhea Basics

Some basics about gonorrhea: N. gonorrhoeae is a bacterium that thrives inside human cells, is transmitted sexually, and causes an infection often known as “The Clap” (from the French for brothel). Sexually-contracted gonorrhea most frequently infects the throat, the cervix, the urethra in both sexes (“the pee tube”), and the rectum. Rectal, throat, and cervical infections are often asymptomatic. About half of women and around 5 percent of men who are infected show no symptoms. When there are symptoms, they are burning with urination and penile discharge men, and pelvic pain and vaginal discharge in women. Gonorrhea can lead to infertility (in both sexes, but more commonly in women), increased risk of ectopic pregnancy (a life-threatening situation), increased risk of contracting HIV from sexual contact, and can even be fatal. With an estimated 700,000 new cases of gonorrhea in the US each year, and the rise of the nasty and the nastier strains of gonorrhea, this is something to keep your eye on.

References

CDC Grand Rounds: The Growing Threat of Multidrugg-Resistant Gonorrhea (February 013) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a3.htm) LA Times: New 'superbug' strain of gonorrhea resistant to all available antibiotics; researchers fear global outbreak (July 2011) (http://articles.latimes.com/2011/jul/11/news/la-heb-antibiotic-resistant-gonorrhea-07112011) LA Times: Antibiotic-resistant gonorrhea discovered; are 'superbug' chlamydia, syphilis strains next? (July 2011) (http://articles.latimes.com/2011/jul/12/news/la-heb-bacterial-stds-20110712)