The World Health Organization released new guidelines for treating gonorrhea Tuesday, and recommended a class of antibiotics called cephalosporins for treatment. Quinolones, the antibiotic class it had recommended in the past, is no longer effective against the quinolone-resistant strains of gonorrhea that have been emerging worldwide.
The new guidelines come on the heels of a Centers for Disease Control and Prevention report in July that found Neisseria gonorrhoeae ― that is, the bacteria that causes gonorrhea ― could be developing resistance to our last-line antibiotics that treat it.
The CDC’s current gold standard treatment for gonorrhea is a combination of two drugs, azithromycin and ceftriaxone, to ensure that if one drug doesn’t kill the bacteria, the other will finish the job. Now, a rise in antibiotic resistance among these two bacteria since 2014 has experts worried.
“History has taught us that this bacteria has the ability to develop resistance to antibiotics, and sometimes it can do it quite quickly,” Dr. Robert Kirkcaldy, a medical epidemiologist in the CDC’s STD prevention division told The Huffington Post.
“Our ability to cure people of gonorrhea is going to fade unless we take steps now address growing antibiotic resistance.”
That said, the United States has not encountered any cases of gonorrhea that are untreatable so far, and despite rising antibiotic resistance, overall resistance rates for the combination treatments are relatively low: just 2.5 percent for azithromycin and 0.8 percent for ceftriaxone.
As it stands, gonorrhea is the second-most common sexually transmitted infection in the United States, with more than 350,000 reported cases of the infection in 2014. And while gonorrhea has traditionally has been easy to cure, if left untreated, it can cause severe reproductive health problems for women, including pelvic inflammatory disease, infertility and ectopic pregnancy.
A perfect storm: cunning bacteria, too few drugs
Our blind faith in innovation and technology is partially to blame for antibiotic-resistant bacteria’s rise. An over-reliance on these medicines, including for infections that are not bacterial, has hastened bacterial mutations and helped contribute to antibiotic resistance.
To keep up with infectious bacteria’s evolution, we need to discover new antibiotics if we want to battle gonorrhea version 2.0.
Unfortunately, we’re not keeping up our end of the bargain. Antibiotic discovery peaked in the 1950s, and according to Pew Charitable Trusts, we haven’t discovered a registered class of antibiotics since 1984.
“If there were an unlimited number of drugs, it may not be an issue,” Kirkcaldy said. “But the number of new drugs is dropping at the same time that bacteria continues to evolve and develop new resistance.”
Discovering new antibiotics is difficult and costly, and there isn’t much incentive for drug companies to invest in it, according to David Payne, head of the Antibacterial Discovery Performance Unit at GlaxoSmithKline.
“The problem with this therapy area is that the return on investment on an antibiotic ― if you apply the traditional pharmaceutical model ― is very low,” Payne told the podcast Signal in July. As it stands, GlaxoSmithKline is one of the only big drug makers left in antibiotic production.
”When you couple all of the challenges of discovering and developing antibiotics with the fact that the return on investment in the current pharmaceutical model is very low, this becomes a very unattractive area for companies to invest in,” Payne said.
The rise of superbugs
Earlier in July, experts confirmed the second case of a superbug resistant to the last-line of antibiotics in a patient who had undergone surgery in a New York hospital in 2015. Following the report, experts expressed fear that antibiotic-resistant infections could become a routine reality in the near future.
The CDC considers infections acquired in healthcare settings to be among the most urgent and serious antibiotic-resistant bacteria threats, because they can lead to sepsis or death.
What many Americans might not realize is how different the strains of antibiotic-resistant bacteria are from one another. “The bugs that affect people who were in the intensive care unit are going to be different than other infections that affect people in the community or other STDs,” Kirkcaldy said.
Two million people in the United States become infected with antibiotic-resistant bacteria every year, and 23,000 die as a direct result of those infections, the CDC reports.
How to turn the tide on antibiotic resistance
“We need to try to prevent these infections from occurring in the first place,” Kirkcaldy stressed.
To protect yourself from gonorrhea and other sexually transmitted infections, practice abstinence or use condoms correctly every time you have sex. High-risk individuals, including women younger than 25, people who have multiple sexual partners or those with a new sexual partner, should be screened for gonorrhea every year.
And if you do become infected, treatment ― for both you and your recent partners ― is paramount. It’s also a step that doctors sometimes overlook.
“Not only will that protect their partners, but it will also prevent the spread of the infection in the community and will protect the initial patient, because then he or she has less of a likely chance of getting it again,” Kirkcaldy said.
Beyond preventing and treating sexually transmitted diseases, the World Health Organization has a few suggestions for things doctors, patients and industry can do to fight back against antibiotic resistance.
Antibiotic use in animals is a particularly pressing problem. The same low-dose antibiotics that protect livestock from infection and allow it to grow faster, can pass resistant bacteria to humans through food.
In the medical realm, health care workers need to stop prescribing antibiotics unless they are absolutely necessary. In turn, patients shouldn’t ask for them unless they have a confirmed bacterial infection. As it stands, almost one third of antibiotics are currently prescribed unnecessarily.
From a public health perspective, the U.S. government is already taking action to address the imminent threat of antibiotic resistance. The government’s National Action Plan allocated $160 million for the CDC to ramp up testing, surveillance and drug development, specifically strengthening local health departments to monitor and prevent outbreaks. In addition, the National Institutes of Health received a $100 million budget increase to fight antimicrobial resistance.
Still, experts aren’t completely reassured by the government windfall.
“It’s a big deal, I totally agree, but I’m still a little shocked that it hasn’t happened sooner,” Lance Price, a molecular epidemiologist and director of George Washington University’s Antibiotic Resistance Action Center told the Washington Post in December.
“I would hate for people to think that this is actually sufficient.”
Update: This story has been updated to include the WHO’s new gonorrhea treatment recommendations.