The Clap is Back!

Sexually transmitted disease
Sexually transmitted disease (Photo credit: Wikipedia)

With the presence of non-curable viral sexually transmitted disease (herpesvirus and HIV) at the forefront of public fear and awareness it is very easy to think of the bacterially induced STD’s as curable and less dangerous. However, one of the key challenges faced by the medical community today is the rapidly rising rates of antibiotic resistance in bacteria as diverse as M. tuberculosis to E. coli. This rising tide of antibiotic resistance is not restricted to certain species and has been more recently documented in Neisseria gonorrhoeae, the causative agent of gonorrhea, also colloquially known as “the clap.”

While this this was once regarded as a minor disease that could be easily cured it is quickly becoming apparent to medical practitioners that treatment of this disease is increasingly difficult1. Many of the standard antibiotics used to treat this bacterial infection such as the penecillins or tetracyclines no longer work. This is primarily due to the fact that in many cases antibiotics are abused and not used properly, leading to the selection for strains of bacteria that are progressively more and more resistant to antibiotics. It is a rather stunning example of evolution occurring in real-time due to human actions. In fact, several isolates of t N. gonorrhoeae have been found to be resistant to cephalosporins such as ceftriaxone, which are considered our last line of defense. What this means is that we are nearing the end of the era in which we can treat this disease effectively. Without the development of additional novel and more powerful antibiotics we face the inability to cure infection, leaving patients to either resolve the infection on their own or to become chronically infected, further spreading the disease and risking sterility.

For readers not familiar with the disease, the common hallmarks of gonorrhea or “the clap” are a painful sensation when urinating, a white or even greenish discharge from the penis in men, and increased vaginal discharge in women. Symptoms are usually milder in women than in men and oftentimes infection in both men and women is asymptomatic and never diagnosed. Currently, the CDC estimates that over 700,000 Americans become infected with the bacterial annually. This bacteria can also infect the rectum and the throat, leading to similar symptoms and pain. It is possible to contract this infection more than once, as infection does not lead to immunity. More importantly, when left untreated this disease can manifest as pelvic inflammatory disease in women (PID) that can lead to sterility and the inability to have children. This outcome of infection is often unknown until years later when a woman wants to become pregnant and cannot conceive due to scarring of the uterine and fallopian tissue from N. gonorrhoeae. Sterility in men is also a possible outcome of N. gonorrhoeae infection because if left untreated it can progress to epididymitis, an inflammation of the ducts attached to the testicles. A more comprehensive list of symptoms can be found on the Centers for Disease Control website.

Chronic asymptomatic infections (at least in the initial stages) are a hallmark of this disease, where it can take upwards of a month after infection to develop noticeable symptoms. During this latent phase it is still possible to transmit the disease to sexual partners. As a result gonorrhea can spread efficiently among sexually active populations that do not utilize safer-sex practices by using barrier methods such as condoms. Even then, barrier methods are not 100% effective in preventing the transmission of STDs, and as such the safest way to avoid infection is abstinence or sex inside a monogamous relationship in which both partners have been tested.

The discovery of near total drug resistance in Neisseria gonorrhoeae has generated a problem at the intersection of microbiology, pharmacology, and public health. Regular testing to determine if individuals are infected is critical to eradicating this disease and stopping its spread through the population but will not be enough.It is important to remember that we have to approach issues such as this from both sides, as better antibiotics will not solve breakdowns in public health just as increased public health practices will still need better antibiotics to combat this problem. So my readers, please remember to use safer-sex practices whenever possible (which is always!) Protect yourself and your partner(s) because the day may come when we cannot cure this disease with the tools at hand.

 

1.           Bolan, G.A., Sparling, P.F. & Wasserheit, J.N. The emerging threat of untreatable gonococcal infection. The New England journal of medicine 366, 485-7 (2012).

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