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Study Warns of Drug-Resistant Gonorrhea


Story at-a-glance -

  • Gonorrhea is increasingly becoming resistant to available drug treatments, and as such may soon pose a major public health threat, according to a US Centers for Disease Control and Prevention (CDC) report
  • The World Health Organization (WHO) already recognizes drug-resistant gonorrhea as "an emergency," with several countries, including Australia, France, Japan, Norway, Sweden, and the United Kingdom, experiencing increasing infections
  • Gonorrhea is one of 18 drug-resistant superbugs identified as "urgent, serious and concerning threats" to humankind
  • Agricultural uses of antibiotics account for about 80 percent of all antibiotic use in the US; this low-dosage usage is implicated as a major contributor to the spread of antibiotic-resistant bacteria
  • Each year, two million American adults and children become infected with antibiotic-resistant bacteria, and at least 23,000 of them die as a result

By Dr. Mercola

Cases of the sexually transmitted disease gonorrhea have been on the decline in the US since the 1970s. However, a new report from the U.S. Centers for Disease Control and Prevention (CDC) hints that this might not be the case for long.

Gonorrhea is increasingly becoming resistant to available drug treatments, and as such may soon pose a major public health threat. Antibiotic-resistant gonorrhea first emerged when I was in medical school in the late 1970s. By the 1980s, the antibiotics penicillin and tetracycline were no longer effective against it.

Next, gonorrhea resistant to fluoroquinolone antibiotics emerged, leaving only one class of antibiotic drugs, cephalosporins, left to treat it. Now, as you might suspect, gonorrhea is fast becoming resistant to cephalosporins – the last available antibiotics to treat it.

Drug-Resistant Gonorrhea May Soon Be a Major Public Health Threat

Gonorrhea infects about 820,000 people each year in the US. Although it often causes no symptoms, it may initially cause painful urination or discharge from the vagina or penis.

It used to be easy to cure gonorrhea with antibiotics, but increasing drug-resistant strains are changing the game, making this one STD that could put you at risk of permanent health damage. If left untreated, or if unable to be treated due to drug resistance, gonorrhea can cause pelvic inflammatory disease (PID) in women, leading to:1

  • Formation of scar tissue that blocks fallopian tubes
  • Ectopic pregnancy
  • Infertility
  • Long-term pelvic and abdominal pain

In men, gonorrhea may cause pain in the tubes attached to the testicles or lead to sterility. In rare cases, gonorrhea may also infect your blood or joints, which may be life threatening.

The World Health Organization (WHO) already recognizes drug-resistant gonorrheaas "an emergency," with several countries, including Australia, France, Japan, Norway, Sweden, and the United Kingdom, experiencing increasing infections. As the CDC reported, if cephalosporin-resistant gonorrhea begins to spread in the US, it's likely to increase incidence rates significantly.2

According to the CDC report, there are two reasons for the likely increased incidence. First, people may stay infected longer, which increases the chances of spreading it to others. Second, and even more worrisome, they noted that drug-resistant gonorrhea may have mutated to infect people even more easily:

"Mutational changes in the organism that conferred resistance or co-occurred with resistance determinants might have supported gonococcal transmission," the CDC noted.

The Last Remaining Treatment Option

Because of rising resistance, the CDC has changed the treatment recommendations for gonorrhea to a dual therapy involving an injectable cephalosporin and a second antimicrobial drug, given simultaneously. They describe this as "the only remaining recommended first-line treatment option for gonorrhea."

Although cases of cephalosporin-resistant gonorrhea have not yet shown up in the US, it is already circulating in Japan and Europe -- a similar trend to what happened when the last widespread resistance developed.

So as the CDC reported, it's likely that even cephalosporins will soon become ineffective against gonorrhea. According to the CDC:3

"Neisseria gonorrhoeae has been remarkably adept at acquiring and maintaining resistance to antimicrobial drugs used for treatment, such as penicillin, tetracyclines, and fluoroquinolones (e.g., ciprofloxacin). After first spreading in Hawaii and California during the late 1990s and early 2000s, ciprofloxacin-resistant gonococcal strains became increasingly prevalent in the United States during the 2000s.

By 2007, the Centers for Disease Control and Prevention (CDC) no longer recommended ciprofloxacin or other fluoroquinolones for treatment of gonorrhea, which make the cephalosporins cefixime or ceftriaxone the only remaining recommended treatment option

the possible emergence and spread of cephalosporin resistance could eventually threaten the effectiveness of this regimen and pose a major public health challenge."

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Drug-Resistant Gonorrhea Is One of 18 Emerging Superbugs Threatening Humankind

If the idea of drug-resistant gonorrhea concerns you, you'll be equally alarmed to know there are many other resistant organisms "walking" among us. But, unlike gonorrhea, which is transmitted primarily through sexual contact, other drug-resistant pathogens are spread more readily – through contaminated food, water, or even dust particles.

The majority of the highly dangerous bacteria are in the Gram-negative category, because that variety has body armor that makes it extremely tough. Some forms are now exhibiting "panresistance"—meaning, resistance to absolutely every antibiotic in existence. In the CDC's report "Antibiotic Resistance Threats in the United States, 2013," the following 18 superbugs are identified as "urgent, serious and concerning threats" to humankind:4

Carbapenem-resistant Enterobacteriaceae (CRE): A family of Gram-negative bacteria that are prominent in your gut growing increasingly resistant to nearly all types of antibiotics
Drug-resistant Neisseria gonorrhoeae: The sexually transmitted disease gonorrhea is becoming increasingly resistant to the last type of antibiotics left to treat it, having already become resistant to less potent antibiotics. Strains of the disease that are resistant to the class of antibiotic drugs called cephalosporins have appeared in several countries.
Multidrug-resistant Acinetobacter: Appeared in the US after Iraq and Afghanistan war vets returned home. Tough enough to survive even on dry surfaces like dust particles, making it easy to pass from host to host, especially in hospital environments
Drug-resistant Campylobacter: Campylobacter is the fourth leading cause of foodborne illness in the US. Campylobacter bacteriaare unique in that they secrete an exotoxin that is similar to cholera toxin.
Fluconazole-resistant Candida (a fungus)
Extended spectrum beta-lactamase producing Enterobacteriaceae (ESBLs): ESBLs are enzymes produced by certain types of bacteria, which render the bacteria resistant to the antibiotics used to treat them. ESBL-producing E. coli, for example, are resistant to penicillins and cephalosporins, and are becoming more frequent in urinary tract infections
Vancomycin-resistant Enterococcus (VRE): Increasingly common in hospital settings
Multidrug-resistant Pseudomonas aeruginosa: Linked to serious bloodstream infections and surgical wounds, can lead to pneumonia and other complications; some are resistant to nearly every family of antibiotic
Drug-resistant Non-typhoidal Salmonella and Salmonella Typhi
Drug-resistant Shigella: An infectious disease caused by Shigella bacteria
Clostridium Difficile (C. Diff): Can live in the gut without causing symptoms, but attacks when your immune system is weakened. C. Diff is on the rise -- infections increased by 400 percent between 2000 and 2007 -- and is becoming increasingly antibiotic-resistant
Methicillin-resistant and Vancomycin-resistant Staphylococcus Aureus (MRSA and VRSA): Gram-positive bacteria infecting about 80,000 people each year, can lead to sepsis and death. Increasing in communities, although decreasing in hospitals over the past decade; recent evidence points to factory-scale hog CAFOs as a primary source. MRSA is also a significant risk for your pets
Drug-resistant Streptococcus pneumoniae: A leading cause of pneumonia, bacteremia, sinusitis, and acute otitis media
Drug-resistant tuberculosis: Extensively resistant TB (XDR TB) has a 40 percent mortality rate and is on the rise worldwide. Tuberculosis is one of the most infectious diseases because it's so easily spread through the air when infected people cough or sneeze
Erythromycin-resistant Group A and Clindamycin-resistant Group B Streptococcus

What Does the Agricultural Industry Have to Do with It?

Animals such as cattle and chickens are often fed antibiotics at low doses for disease prevention and growth promotion, and those antibiotics are transferred to you via meat, and even via the manure used as crop fertilizer. Agricultural uses of antibiotics actually account for about 80 percent of all antibiotic use in the US,5 so it's undoubtedly a major source of human antibiotic consumption.

Basically, unless you're eating organically raised meats, every single piece of meat you eat will give you a small dose of antibiotics, and this low-dosing is a major part of the problem, because when the bacteria are not killed by the antibiotic, they become stronger.

Unfortunately, when the US Food and Drug Administration (FDA) issued its guidance on agricultural antibiotics in December 2013, it only went so far as to ask drug companies to voluntarily restrict the use of antibiotics that are important in human medicine by excluding growth promotion in animals as a listed use on the drug label. This would prevent farmers from legally using antibiotics such as tetracyclines, penicillins, and azithromycin for growth promotion purposes. But this guidance is not likely to protect your health at all, and was exactly what the drug companies were hoping for. As previously reported by Scientific American:6

"[T]he success of the FDA's new program depends on how many companies volunteer to change their labels over the next 90 days in alignment with the FDA cutoff period. (Companies that do change their labels will have three years to phase in the changes.) And then there are myriad questions about how this would be enforced on the farm."

Another proposed amendment to the FDA's animal drug regulations (the veterinary feed directive) would require farmers to obtain a veterinary prescription before using antibiotics in animal feed for any reason. If this amendment makes it through the comment period intact, it might have a far greater impact…To get an idea of just how many antibiotics are used in agriculture, as opposed to directly by humans, check out the Science News graphic below:7

US Antibiotic Use Infographic Preview

Source: A. Hollis and Z. Ahmed/NEJM 2013; Chicken: pinare/ShutterStock; other Icons: E. Otwel

What Will Happen if Antibiotics Stop Working?

According to the "Antibiotic Resistance Threat Report" published by the CDC in 2013,8 two million American adults and children become infected with antibiotic-resistant bacteria each year, and at least 23,000 of them die as a direct result of those infections. Even more die from complications.

Unless something changes, these numbers are only going to get worse. What we're seeing is the evolution of bacteria. Basically, microorganisms have learned to teach each other how to outsmart the best pharmaceutical drugs we have to offer, and they are definitely winning the battle.

Drug companies have little financial incentive to produce new antibiotics, as they don't make nearly the profits of medications meant to be taken for a lifetime, such as cholesterol-lowering medications. So new "miracle" drugs that can replace the antibiotics that are quickly dropping off the usefulness spectrum are few and far between, and medicine has very few options when the antibiotic pipeline completely dries up.

The bottom line is, if ALL antibiotics fail, it will in effect mark an end to modern medicine as we know it—and we are quickly heading in that direction. Common illnesses such as bronchitis or strep throat may turn into deadly sepsis. Surgeries previously considered low risk or "routine," such as hip replacements, might suddenly be too risky without antibiotics. And complex surgeries like organ transplants would essentially not be survivable.

Doing Your Part to Stay Well

The impending superbug crisis has a three-prong solution:

  1. Better infection prevention, with a focus on strengthening your immune system naturally
  2. More responsible use of antibiotics for people and animals, with a return to biodynamic farming and a complete overhaul of our food system
  3. Innovative new approaches to the treatment of infections from all branches of science, natural as well as allopathic

These steps must be taken on a global, and certainly a nationwide, level, however there are some things you can do individually as well. For starters, avoiding antibiotic-resistance is but one of several good reasons to avoid meats and animal products from animals raised in concentrated animal feeding operations (CAFOs). This is in part why grass-fed pastured meats are the ONLY type of meat I recommend. If you're regularly eating meat bought at your local grocery store, know that you're in all likelihood getting a low dose of antibiotics with every meal... and this low-dose exposure is what's allowing bacteria to adapt and develop such strong resistance.

Additionally, prevent infections as best you can; it is far easier to prevent an infection than to get rid of one. The basic key to keeping your immune system healthy is making positive lifestyle choices such as proper diet, stress management and exercise. Finally, become familiar with natural compounds that have antimicrobial activity, such as garlic, cinnamon, oregano extract, colloidal silver, Manuka honey, probiotics and fermented foods, echinacea, and sunlight and vitamin D. Research has shown that bacteria do not tend to develop resistance to these types of treatments, offering hope for the future.