Prepare yourself for the End Times: The first ever confirmed case of “super gonorrhea” was reported in March, and two similar cases were reported in April. An Englishman and two Australians developed the infection after having unprotected sex in Southeast Asia, according to a statement from Public Health England.
All of which raises the question: What the hell did they expect?
The Englishman was eventually treated with ertapenem — a powerful antibiotic typically reserved for serious infections — after his specific case of “super gonorrhea” resisted both azithromycin and ceftriaxone (the standard treatments). This was clearly an extremely severe case, considering the World Health Organization calls ceftriaxone the “current last-resort treatment” for gonorrhea. The state of the Australians and their infections is currently unknown.
To make sense of this sudden rise in “super gonorrhea,” I reached out to Hunter Handsfield, professor emeritus of medicine at the University of Washington Center for AIDS and STD, a former member of the American Sexual Health Association board and a trailblazer in STD research.
Here’s what I learned…
What makes ‘super gonorrhea’ so super?
“It’s ‘super’ only in that it’s resistant to more antibiotics than most strains of gonorrhea,” Handsfield explains, meaning the symptoms of “super gonorrhea” (more appropriately known as “multi-drug-resistant gonorrhea”) aren’t any more intense than those associated with regular gonorrhea. But again, those symptoms are becoming increasingly difficult to resolve. “It’s getting to a point where we’re in danger of strains evolving that aren’t treatable — at least, easily treatable — with any currently available antibiotics.”
Okay, so how did ‘super gonorrhea’ become super in the first place?
The short answer is that we (society at large) rely too heavily on antibiotics. In fact, a 2015 study found that ceftriaxone became increasingly less effective as its popularity grew, which is a problem that doctors face with all antibiotics: Once they’re introduced to the public, bacteria encounter them and begin to evolve their defenses. Worse yet, the more a drug interacts with bacteria out in the world, the more quickly these bacteria will become resistant. This is especially bad news considering how common gonorrhea is (and therefore, how often it must be treated using antibiotics). An estimated 78 million people develop the infection every year, meaning gonorrhea has plenty of chances to become “super.”
As for how we ended up in this unfortunate situation, Handsfield attempts to paraphrase an extremely complicated issue: “I can’t say anything more than what [antimicrobial-resistance pioneer Stanley Falkow] and other experts have said on a broad level: That is, there’s a societal, legislative, regulatory approach, and most of us in this field would say that Big Business and Big Pharma have been too influential in their success in avoiding the regulatory issues that relate to both the sales of the product — the moneymaking for the antibiotics industry — and the economics of raising food animals. Their arguments in favor of continued antibiotics use have overridden the pleas and recommendations of more objective scientists at the Food and Drug Administration.”
Alas, Big Pharma strikes again!
Wow, that’s heavy. And disheartening. So what do we do now? Or better put, how can we stop ‘super gonorrhea’ from becoming even more super?
While tackling the issue mentioned above may be beyond any single individual, Handsfield says that both physicians and patients can be more cautious about prescribing and using antibiotics. “[The patient] shouldn’t insist on antibiotics,” he says. “A lot of us go to the doctor and say, ‘I’ve got another case of bronchitis. I need another round of Cipro, or another Z-Pak.’ The doctor takes the lower path of resistant and says, ‘Okay, you probably don’t need it, but we’ll do it one more time.’ That one more time happens millions of times per year across the country.”
And while this is definitely the case in the U.S., Handsfield argues that it’s even more of an issue in developing countries. “In Cambodia, Thailand, India and tropical Africa, there are places where antibiotics are available through pharmacies without prescriptions,” he explains. “People just walk in, and talk to a medically untrained pharmacist, who recommends whatever he or she feels like — and perhaps to make some more profit than anything else.”
It’s no wonder then that the three recent instances of “super gonorrhea” began in Southeast Asia.
Understood. As with everything, though, let’s bring it back to me. Namely, how can I super-avoid ‘super gonorrhea?’
Condoms, duh, especially while abroad. “People who are traveling should remember that condoms are just as important as clean water,” Handsfield emphasizes. And if you forget and it starts to burn when you pee: “If you do return to the U.S. with symptoms, don’t delay. Get them checked out, and make sure that whoever is evaluating you — whether it’s a public STD clinic or a private doctor — knows that you may have acquired this infection wherever you were.”
Sounds super-easy, right?