Last Updated on July 29, 2021 by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT
Gonorrhea’s Progressive Resistance
Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it (cephalosporin antibiotics).
The emergence of cephalosporin-resistant gonorrhea will significantly complicate the ability to treat the bacteria successfully, since there are few antibiotic options left which are highly effective.
Scientists believe overuse or incorrect use of antibiotics, coupled with the bacteria’s astonishing ability to adapt, means the infection is now close to becoming a super bug.
Bacteria that survive antibiotic treatment due to a mutation makes them resistant. Once resistant, they quickly spread their genes in an accelerated process of natural selection. This is a general problem affecting all antibiotics, but gonorrhea is particularly quick to adapt because it is good at picking up snippets of DNA from other bacteria.
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The World Health Organization (WHO) blames the misuse of antimicrobial medicines like antibiotics, antivirals, and antimalarials for the formation of new types of bacteria, viruses, and parasites that resist current treatments. The U.N. health agency is urging governments and doctors to step up surveillance of antibiotic-resistant bacterial infections.
Long-term Consequences
Millions of people may be at risk of running out of treatment options unless urgent action is taken, according to the WHO. Already several countries, including Australia, France, Japan, Norway, Sweden and the United Kingdom are reporting cases of resistance to cephalosporin antibiotics — the last treatment option against the gonorrhea bacteria. Every year an estimated 106 million people are infected worldwide.
We do fear that based on what we are hearing around the world, we will see cephalosporin-resistant bacteria, Dr. Gail Bolan, director of STD prevention at the CDC, said at the time. We don’t know when this is going to happen, but the hope is that we have a few years to identify other treatments.
The long-term consequences of untreated gonococcal infections include persistent urethritis, cervicitis, proctitis and disseminated infections that could lead to pelvic inflammatory disease, infertility, first-trimester abortion, ectopic pregnancy, and maternal death. Health consequences to neonates (babies born to gonorrhea infected moms) include severe infections that may lead to blindness.
In addition, gonococcal urethritis, like many other STIs, significantly increases the risk of acquiring and transmitting HIV infection.
References
- Symptoms
- Shover, Chelsea L., et al. “Accuracy of Presumptive Gonorrhea Treatment for Gay, Bisexual, and Other Men Who Have Sex with Men: Results from a Large Sexual Health Clinic in Los Angeles, California.” LGBT health2 (2018): 139-144.
- Orr, Tamra B. Gonorrhea. The Rosen Publishing Group, Inc, 2015.
- Bonyah, E., et al. “Modelling the effects of heavy alcohol consumption on the transmission dynamics of gonorrhea with optimal control.” Mathematical biosciences 309 (2019): 1-11.
- Moyosore, Adebisi Temitayo. “Adolescent Sexual Development and Sexually Transmittted Infections.” International STD Research & Reviews (2016): 1-11.
- Elawad, N. A. M. “Situation of Sexually Transmitted Infections (STIs) in Sudan.” Adv Reprod Sci Reprod Health In-fertil: ARRHI-102. DOI 10 (2018).
- Testing
- Reekie, Joanne, et al. “Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: a population-based cohort study.” Clinical Infectious Diseases 66.3 (2018): 437-443.
- Wang, Li Yan, et al. “Human Immunodeficiency Virus, Chlamydia, and Gonorrhea Testing in New York Medicaid–Enrolled Adolescents.” Sexually transmitted diseases 45.1 (2018): 14-18.
- Pittman, Ellen, et al. “Patient Acceptability and Feasibility of Self-Collecting Genital Samples for Chlamydia and Gonorrhea Testing in a Community Setting Using Privacy Shelters.” Journal of Adolescent Health 58.2 (2016): S107-S108.
- Hoots, Brooke E., et al. “Self-reported chlamydia and gonorrhea testing and diagnosis among men who have sex with men—20 US cities, 2011 and 2014.” Sexually transmitted diseases 45.7 (2018): 469-475.
- McRee, Annie‐Laurie, Allahna Esber, and Paul L. Reiter. “Acceptability of Home‐Based Chlamydia And Gonorrhea Testing Among a National Sample Of Sexual Minority Young Adults.” Perspectives on sexual and reproductive health 47.1 (2015): 3-10.
- Treatment
- Kerani, Roxanne P., et al. “Gonorrhea treatment practices in the STD Surveillance Network, 2010–2012.” Sexually transmitted diseases 42.1 (2015): 6-12.
- Weston, Emily J., et al. “Adherence to CDC recommendations for the treatment of uncomplicated gonorrhea—STD Surveillance Network, United States, 2016.” Morbidity and Mortality Weekly Report 67.16 (2018): 473.
- Hook III, Edward W., et al. “Efficacy and Safety of Single-Dose Oral Delafloxacin Compared With Intramuscular Ceftriaxone for Uncomplicated Gonorrhea Treatment: An Open-Label, Noninferiority, Phase 3, Multicenter, Randomized Study.” Sexually transmitted diseases 46.5 (2019): 279-286.
- Long, Jill E., Michael R. Wierzbicki, and Edward W. Hook III. “Impact of eligibility criteria on participant enrollment for a randomized clinical trial of gonorrhea treatment.” Sexually transmitted diseases 44.6 (2017): 362.
- Singh, Ameeta E., et al. “Gonorrhea treatment failures with oral and injectable expanded spectrum cephalosporin monotherapy vs dual therapy at 4 Canadian sexually transmitted infection clinics, 2010–2013.” Sexually transmitted diseases 42.6 (2015): 331-336.
- Prevention
- Handsfield, H. Hunter. “Gonorrhea Prevention in the United States: Where Do We Go From Here?.” (2016): 731-732.
- Kirkcaldy, Robert D., et al. “Considering the Potential Application of Whole Genome Sequencing to Gonorrhea Prevention and Control.” Sexually transmitted diseases 45.6 (2018): e29-e32.
- Bowen, Virginia B., et al. “Gonorrhea.” Current Epidemiology Reports 4.1 (2017): 1-10.
- Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
- Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
- Transmission
- Fairley, Christopher K., et al. “Frequent transmission of gonorrhea in men who have sex with men.” Emerging infectious diseases 23.1 (2017): 102.
- Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
- Tuite, Ashleigh R., et al. “Impact of rapid susceptibility testing and antibiotic selection strategy on the emergence and spread of antibiotic resistance in gonorrhea.” The Journal of infectious diseases 216.9 (2017): 1141-1149.
- Bonyah, E., et al. “Modelling the effects of heavy alcohol consumption on the transmission dynamics of gonorrhea with optimal control.” Mathematical biosciences 309 (2019): 1-11.
- Ndeffo-Mbah, Martial L., et al. “Dynamic models of infectious disease transmission in prisons and the general population.” Epidemiologic reviews 40.1 (2018): 40-57.
