This entry is part 2 of 3 in the series STD's and You

As a part of presenting essential information about STD’s, today’s topic is about the increasing prevalence of antibiotic resistant infections; more specifically, the rise of Super Gonorrhea.  The spectre of  antibiotic resistance has now shown its ugly head among sexually transmitted infectious diseases, a problem not likely to get any better in the foreseeable future.  This post is a complete rewrite of an essay I posted at back in 2012.   The importance and relevance of discussing antibiotic resistant sexually transmitted infections has only increased since I first wrote on this topic – we all need to be armed with knowledge on the onset of what’s being called Super Gonorrhea.

MRSA and you

no STD's syringe with hypodermic

I sincerely regret that today’s message is not more sex positive.  Sadly, there are times when current events don’t allow me that luxury.  The news coming from the CDC (Centers for Disease Control and Prevention) is very bleak, it’s as cold and chilling as a Midwestern winter’s day.  For anyone paying attention, the rise of antibiotic resistant infectious disease is not even really news anymore.  Urgent stories of MRSA staph infections were very common in the media some time ago, so much so that they are now “old news”, we don’t hear them so much anymore.    But, there’s no denying that more and more infectious diseases are developing antibiotic resistance these days, it’s all around us.

Methicillin-resistant Staphylococcus aureus, the full name for the more commonly used acronym MRSA,  is perhaps the “poster child” for antibiotic resistant disease.  The disease has touched my life multiple times.  I have a close friend who wears a small scar on her leg, lingering evidence of an antibiotic resistant staph infection that had to be cut away.  Another friend had a similar infection excised from his inner thigh.  Between 20% and 30% of the population are actively colonized by staph at any given time, and studies from 2009 show that as much as 3% of the total population1 is actively colonized by MRSA.  Typical locations for MRSA colonization is ski,n or in their sinuses.

In other words, somewhere between 1 out of 3 and 1 out of 5 people you know are likely colonized, right now, by MRSA.  And, if you know 30 people, odds are good that you know someone who’s colonized with MRSA.   There’s really no avoiding the fact that MRSA is relatively ubiquitous in the average environment today.  It’s also true that more and more infectious diseases are developing antibiotic resistance these days.  I saw that first hand with my Mother, an antibiotic resistant strain of pneumonia was the primary cause of her death in 2011.  Prior to the pneumonia, mom had bacterial cultures that tested positive for: MRSA, C. difficile (a bacterial infection usually caused by the overuse of antibiotics,) as well as an antibiotic resistant strain of Pseudomonas.

cillins and cyclines and sporons, oh my!

no std smallWith the dire news about MRSA and other infectious disease, it should come as no great surprise that sexually transmitted diseases are part of that same trend towards antibiotic resistant bacteria.  My first exposure to the specifics of “super STD’s” was from The Atlantic, who reported the problem back in 2012 with an article titled Here It Comes: Super Gonorrhea.

Did you know gonorrhea can kill you? It can, and it’s also tragically effective at making women infertile. According to her journals, my great aunt Mabel was “barren,” and my grandmother always told me it was probably from gonorrhea. The only reason we don’t hear about these awful complications more often — and we instead think of it as a little oops of an infection (“Can I still drink on these antibiotics?” “Yes.” “Cool.”) — is because we’ve been able to kill it early with relative ease.
But over the past decades, gonorrhea has been mowing down our antibiotics. If this was the Olympic 400 IM, gonorrhea would be the Ryan Lochte and our antibiotics would be the guy from Moldova.
The list of effective antibiotics has been dwindling as the bacteria became resistant, and now it’s down to one. Five years ago, the CDC said fluoroquinolones were no longer effective, but oral cephalosporins were still a common/easy treatment. Now injected ceftriaxone is the only recommended effective drug we have left. And it has to be given along with either azithromycin or doxycycline.
The Super Gonorrhea article, written by James Hamblin, MD, is a pretty stark reminder that we currently live in the waning days of the “golden age of antibiotics”, as we are commonly seeing the medicines of our grandparents and parents rendered obsolete by continually evolving bacteria.

The New Yorker online painted a similar picture just over a month later in a piece called Sex and the Superbug:

As modern medicine has adapted so has the microbe. Natural selection has given rise to strains of the bacterium that are resistant, in varying degrees, to some or all of the treatments applied to them—sulfa drugs, penicillin, tetracyclines, fluoroquinolones, and macrolides. Now only one class of drugs, called cephalosporins—cefixime, a tablet, and ceftriaxone, administered by injection—is known to reliably treat it, and for several years resistance to cefixime has been rising.

Both of those quotes are full of a cocktail of antibiotic names, cillins, sporons, cyclines, and quinolones, families of drugs we’d all rather not know.  Sadly, that’s the reality we face today.  All of the confusing antibiotic drugs (and antibiotic drug families) listed are either already useless, or soon will be completely ineffective against Gonorrhea.  There’s no denying evolution at work here, the microbes simply adapt faster than we can create drugs to safely kill them.

super gonorrhea

WWII Era Poster She May Look Clean But With the point about bacterial evolution made, I’m sure that some of my Evangelical Christian friends will see the hand of God at work behind this obvious act of bacterial evolution.  I mean what else can they see?  It’s not like they accept evolution in any of its forms, it’s purely a matter of faith to them.  They will posit that promiscuity is evil and unhealthy, and this potential epidemic is a sign that God (the Trinity) is displeased with all but purely monogamous lifestyles.  There’s no arguing with faith anyway,

I’m personally think that the onset of antibiotic resistant disease is simply a symptom of the overuse of antibiotics, both in the treatment of human disease, and in our food chain. Far too many chemicals are fed to far too many livestock animals simply because the balance sheet tells a business person that a few extra pennies per head can be garnered. Yes, there is one science that the Religious Right (which is neither truly religious nor, are they right) has faith in, the science of the balance sheet.  Far too many antibiotics are prescribed far too freely for humans as well, but it should be understood that by far the vast majority of antibiotics used in the United States are used by agriculture.

The overwhelming majority of scientists agree, it’s only a matter of time before disease-causing bacteria learn to resist our last antibiotic lines of defense. That future is clearly envisioned in Dr. Hamblin’s article:

Once gonorrhea becomes resistant to the last of our cephalosporin antibiotics — “it’s only a matter of time,” according to Dr. Gail Bolan, Director of STD Prevention at the CDC in today’s announcement — we will have no treatment. Then when it gets into your bloodstream, it will be lethal.

I’ve watched Doctors pull my Mother back from being nearly dead on several occasions in her life. At the end, it involved using antibiotic cocktails which brought her back even from sepsis. Those cures weren’t available in your my grandmother’s day, and they won’t be available in your grandchildren’s day either.

My paternal grandfather, like Al Capone and many other more famous people, died of syphilis. The bacteria got into his brain and disabled him, left him like a zombie, and finally, ultimately extinguished his life. He died in a sanitarium, leaving behind a family with no means of support, the majority of his children were given up for adoption, that they might eat.

When I was younger, that always seemed like a tale from a barbaric time, that thankfully was left in the past. I’m realizing now that the past and the future may not look so different.

  1. MRSA in primary care; NICE CKS, January 2009
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Michael's Musings Super Gonorrhea ~ Coming Soon to a Host Near You
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