Gonorrhea No Longer Treatable


Story at-a-glance -

  • Gonorrhea is increasingly becoming resistant to available drug treatments; a dual therapy is now recommended to treat it, consisting of two antibiotics, ceftriaxone and azithromycin
  • In the U.K., the first case of gonorrhea that’s resistant to both ceftriaxone and azithromycin has been reported
  • The man was diagnosed in early 2018, and it’s believed he contracted the infection via sexual activity with a person in Southeast Asia about a month prior
  • The patient is now being treated with an intravenous antibiotic called ertapenem, which is related to ceftriaxone; the infection appears to be responding to the new treatment but officials are planning to retest the patient to determine if it was successful

By Dr. Mercola

Gonorrhea is a sexually transmitted disease (STD) that infects an estimated 820,000 people in the U.S. annually, mostly those between the ages of 15 and 24.1 Worldwide, 78 million people are infected with gonorrhea every year.2 Caused by the Neisseria gonorrhoeae bacterium, gonorrhea is spread by through sexual contact, as well as from mother to baby during childbirth. This bacterial infection has long been easily treated with antibiotics, but gonorrhea is increasingly becoming resistant to available drug treatments.

As such, it’s now being described as an urgent public health issue. Dr. Teodora Wi, medical officer of human reproduction at the World Health Organization (WHO) said, "The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”3 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.

First Strain of Super-Resistant Gonorrhea Reported

In 2013, the U.S. Centers for Disease Control and Prevention (CDC) estimated that about one-third of gonorrhea cases were resistant to at least one antibiotic. They updated treatment guidelines at that time to include a dose of the antibiotic ceftriaxone along with a second antibiotic. As of 2018, the CDC still recommends this dual therapy to treat gonorrhea, specifically a single 250-milligram (mg) dose of intramuscular ceftriaxone and 1 gram (g) of oral azithromycin.4

The two-pronged treatment initially appeared to be working, pushing resistance rates from 1.4 percent in 2011 to 0.4 percent in 2013. However, according to CDC data published in JAMA, “improvements in susceptibility may be short-lived.”5,6 According to the CDC:7

“Gonorrhea has developed resistance to nearly all of the antibiotics used for its treatment. We are currently down to one last recommended and effective class of antibiotics, cephalosporins, to treat this common infection. This is an urgent public health threat because gonorrhea control in the United States largely relies on our ability to successfully treat the infection.”

In the U.K., meanwhile, the first case of gonorrhea that’s resistant to both ceftriaxone and azithromycin has been reported.8 The man was diagnosed in early 2018, and it’s believed he contracted the infection via sexual activity with a person in Southeast Asia about a month prior.

Gwenda Hughes, consultant scientist and head of the sexually transmitted infection section at Public Health England (PHE), said in a statement, “[The infection] … is very resistant to the recommended first-line treatment … This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.”9

The patient is now being treated with an intravenous antibiotic called ertapenem, which is related to ceftriaxone. The infection appears to be responding to the new treatment but officials are planning to retest the patient in April to determine if it was successful. “We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” Hughes said.10

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What Are the Health Risks of Gonorrhea?

Although gonorrhea often causes no symptoms, it can lead to a burning or painful sensation when urinating, white, green or yellow discharge from the penis, increased vaginal discharge, painful or swollen testicles in men, and vaginal bleeding between periods in women. Rectal infections with gonorrhea may lead to anal discharge, itching, soreness and bleeding or painful bowel movements.

If left untreated (or if the disease progresses because it’s resistant to treatment), gonorrhea can lead to pelvic inflammatory disease (PID) in women, which can cause:

  • Scar tissue to form in the fallopian tubes
  • Ectopic pregnancy
  • Infertility
  • Long-term pelvic and abdominal pain

In men, gonorrhea can lead to pain in the tubes attached to the testicles, which can lead to infertility. In addition, if gonorrhea spreads to your blood or joints it can be life-threatening, and it also increases your risk of contracting HIV. If you’re pregnant and you pass gonorrhea to your baby during childbirth, it can lead to blindness, joint infection or a life-threatening blood infection in the baby.11

Drug-Resistant Gonorrhea Is on the Rise

From 2013 to 2014 cases of antibiotic-resistant gonorrhea doubled, with rates reaching 0.8 percent. WHO recognizes drug-resistant gonorrhea as "an emergency," with several countries, including Australia, France, Japan, Norway, Sweden and the U.K. experiencing increasing infections. Further, in a study of 77 countries, WHO reported widespread resistance to ciprofloxacin, with 97 percent of countries reporting drug-resistant strains, and increasing resistance to azithromycin, with 81 percent of countries reporting resistance.

Further, 66 percent of countries had seen gonorrhea strains resistant to extended-spectrum cephalosporins (ESCs), oral cefixime or injectable ceftriaxone, the current last-resort treatments. According to WHO, “Currently, in most countries, ESCs are the only single antibiotic that remain effective for treating gonorrhea. But resistance to cefixime — and more rarely to ceftriaxone — has now been reported in more than 50 countries.”12

What’s more, WHO’s Wi said, "These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhea is actually more common." Adding to the problem is that drugs in the pipeline to treat drug-resistant gonorrhea are few and far between. Only three new candidate drugs are in various stages of development. WHO continued:13

“The development of new antibiotics is not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished.”

As a sexually transmitted disease, gonorrhea can be prevented via safe sex practices, such as being in a mutually monogamous relationship with a partner who does not have gonorrhea, as well as using condoms.

“It is better to avoid getting or passing on gonorrhea in the first place and everyone can significantly reduce their risk by using condoms consistently and correctly with all new and casual partners,” PHE’s Hughes noted.14 Curbing the worldwide spread of antibiotic-resistant disease, however, is a much more complicated undertaking.

Many Types of Antibiotic-Resistant Disease Are Growing

Each year, more than 2 million Americans are sickened, and at least 23,000 are killed, by antibiotic-resistant superbugs.15 Bacteria are, in essence, hard-wired to adapt to threats such as antibiotics and, at such point in time when they adapt to resist all of them, infections that were once easily treated will undoubtedly return with renewed force.

We’re seeing this increasingly in the U.S. Antibiotic overuse and inappropriate use bear a heavy responsibility for creating the superbug crisis we are facing today.

The pervasive misuse of antibiotics by the agriculture industry plays a significant role, as agriculture accounts for about 80 percent of all antibiotics used in the U.S. CAFOs (concentrated animal feeding operations), in particular, are hotbeds for breeding antibiotic-resistant bacteria because of the continuous feeding of low doses of antibiotics to the animals, which allows pathogens to survive, adapt and eventually thrive.

The European Centre for Disease Prevention and Control (ECDC) ruled that antibiotic resistance is a major threat to public health, worldwide, and the primary cause for this man-made epidemic is the widespread misuse of antibiotics.16 In the U.S., the CDC noted that without “immediate, nationwide improvements in infection control and antibiotic prescribing,” drug-resistant infections will only continue to increase…17

Between 2000 and 2015, human consumption of antibiotics has risen by 65 percent, reaching 42 billion doses a year, according to research published in the Proceedings of the National Academy of Sciences.18

The increase was driven by low- and middle-income countries and, if no policy changes are made, it’s estimated that global antibiotic consumption will rise up to 200 percent higher by 2030, perpetuating the problem. Worldwide, 700,000 people die every year due to antibiotic-resistant disease, and it’s estimated that more people will be affected by it than cancer by 2050.19

In addition to drug-resistant gonorrhea, which is classified as an urgent threat by the CDC, one of the most urgent antibiotic-resistant health threats is carbapenem-resistant Enterobacteriaceae (CRE), which are resistant to the class of antibiotics called carbapenems.20 Drug-resistant clostridium difficile (C. difficile) is another urgent threat that causes life-threatening diarrhea. C. difficile causes nearly half a million infections in the U.S. annually, along with 15,000 deaths.21

How to Protect Yourself From Drug-Resistant Disease

The stronger your immune defenses, the less chance a microbe — antibiotic-resistant or otherwise — will have of gaining a foothold in some part of your body. Below are some basic strategies for supercharging your immune system. In addition, in an era where we’re facing the potential end of antibiotics as we know them, it’s important for everyone to voice their opinion about the rampant overuse of antibiotics on CAFOs by supporting only those farms that aren’t perpetuating the problem.

I encourage you to either buy your animal products direct from a trusted farm or look for the American Grassfed Association (AGA) logo, a grass fed standards and certification for American-grown grass fed meat and dairy.22

Optimize your diet. Avoid foods that tax your immune system such as synthetic trans fats, fried foods, processed foods, sugar and grains; reduce net carbohydrates (sugar, grains, fructose) and protein, replacing them with high-quality fats.

Most of your diet should be fresh, whole foods, like organic vegetables and grass-pastured meats and dairy, and beneficial fats, such as raw, grass fed butter and fermented dairy from grass-pastured animals, cheese, egg yolks and avocados. A great portion of your immune system resides in your GI tract, which depends on a healthy, balanced gut flora.

One of the best ways to support this is by incorporating naturally fermented foods into your diet, working up to 4 to 6 ounces per day. One large serving of several ounces of fermented foods can supply you with around 10 trillion beneficial bacteria, which is about 10 percent of the population of your gut. You can take a high-quality probiotic supplement, but the actual fermented foods offer the greatest benefit. You may also want to consider a ketogenic diet.

Exercise regularly. Exercise improves the circulation of immune cells in your blood. The better these cells circulate, the more efficient your immune system is at locating and eliminating pathogens in your body. Make sure your fitness plan incorporates weight training, high-intensity interval exercises, stretching and core work, and get plenty of nonexercise movement daily (strive to sit for fewer than three hours a day).

Get plenty of restorative sleep. Sleep deprivation has the same effect on your immune system as physical stress or disease,23 which is why you may feel ill after a sleepless night.

Have good stress-busting outlets. High levels of stress hormones can diminish your immunity, so be sure you’re implementing some sort of stress management. Meditation, prayer, yoga and Emotional Freedom Techniques (EFT) are all excellent strategies for managing stress, but you’ll have to find what works best for you.

Optimize your vitamin D levels. Studies have shown that inadequate vitamin D can increase your risk for MRSA and other infections. Your best source of vitamin D is through exposing your skin to the sun.

Monitor your vitamin D levels to confirm they’re in the therapeutic range, 60 to 80 ng/ml. If you can’t get regular sunlight exposure, consider taking an oral vitamin D3 supplement. Just keep in mind that if you take high-dose vitamin D, you may also need to increase your intake of calcium, magnesium and vitamin K2 for proper balance.