STD Prevalence Skyrockets Amid Concerns Over Growing Antibiotic Resistance

std antibiotic resistance

Story at-a-glance -

  • Three of the more commonly transmitted diseases have reached record levels in the U.S. Nationwide, there were 1.6 million cases of chlamydia in 2016, 470,000 cases of gonorrhea and 28,000 new cases of syphilis
  • Mutations of the Neisseria gonorrhoeae bacteria that causes gonorrheal infections have led to a high incidence of antibiotic resistance, making it extremely difficult to treat
  • Research looking at syphilis samples from the U.S., South America, Europe, Africa and Australasia found both of the two main strains of syphilis have developed antibiotic resistance
  • STD prevalence in California has increased by 45 percent in the past five years. In 2017, 300,000 cases of chlamydia, gonorrhea and syphilis were reported, 54 percent of cases occurring in those under the age of 25
  • The number of babies born infected with syphilis quadrupled, and with it, stillbirths spiked as well. Of the 278 congenital syphilis cases on record in California last year, 30 resulted in stillbirth, which is triple the number of syphilis-related stillbirths reported in 2016

By Dr. Mercola

Cases of sexually transmitted diseases (STDs) were in decline until the 1970s, at which point the trend reversed.1 What's worse, in more recent years, some of the STDs typically requiring antibiotics have become resistant to the drugs and have turned deadly. No less than three of the more commonly transmitted diseases have now reached record levels in the U.S.

Nationwide, there were 1.6 million cases of chlamydia in 2016, 470,000 cases of gonorrhea and 28,000 new cases of syphilis. Although all three have the potential of being cured with antibiotics, mutations of the bacteria that cause these infections have led to increasing antibiotic resistance.

Syphilis Becoming Increasingly Antibiotic-Resistant

For example, syphilis is resistant to azithromycin, the second drug of choice for this infection,2 and recent research3 looking at syphilis samples from the U.S., South America, Europe, Africa and Australasia found both of the two main strains of syphilis have developed antibiotic resistance.

The Street Strain 14 (SS14), which is a newer strain, appears to be far more drug-resistant than the older Nichols strain. A whopping 90 percent of the SS14 samples had drug resistance genes. There's also evidence showing all three STDs are developing multidrug resistance (pan-resistance). Gonorrhea is already resistant to all antibiotics that have been used against it, and is rapidly developing resistance against cephalosporins, the drug of last resort.

STD Rates Skyrocket in California

According to a recent report4 by the California Department of Public Health, STD prevalence in the state has increased by 45 percent in the past five years alone.5,6 In 2017, 300,000 cases of chlamydia, gonorrhea and syphilis were reported, with 54 percent of cases occurring in those under the age of 25. In addition to a decline in condom use, lack of sex education and fewer STD clinics due to budget cuts, state health officials believe internet dating apps have played a significant role in this troubling trend.

As noted by James Watt, chief of the division of communicable disease control for the Department of Health, "The internet allows for a broadening of sexual networks, and the broader that gets the more opportunity you have for sexually transmitted diseases to spread." African-Americans are disproportionately affected, with chlamydia and gonorrhea rates five times higher than Caucasians. They also have double the rate of syphilis.

Distinct variations can also be seen between the sexes. Chlamydia rates are 60 percent higher among women than men, and while syphilis is still more prevalent among men, it has suddenly skyrocketed among women, increasing sevenfold between 2012 and 2016.

As noted by Watt, this is of great concern, as "syphilis can have long-term complications like blindness, hearing loss and other neurological problems." Men, meanwhile, have twice the rate of gonorrhea than women. Both gonorrhea and syphilis are more prevalent among bisexual and homosexual men because these diseases are most readily transmitted during male-on-male sex.

Stillbirths Caused by Syphilis Infection Spiked Last Year  

The number of babies born infected with syphilis contracted from their mother has also quadrupled and, with it, stillbirths have spiked as well.7 Of the 278 congenital syphilis cases on record in California last year, 30 resulted in stillbirth, which is triple the number of syphilis-related stillbirths reported in 2016.

Aside from stillbirth, congenital syphilis can also result in permanent disabilities, including blindness. Other STDs can also wreak havoc on a woman's reproductive health. Both chlamydia and gonorrhea can result in infertility and ectopic pregnancy. If you have an STD, make every effort to avoid pregnancy until you have been successfully treated and have been cleared by your doctor.

Gonorrhea Increasingly Resistant to Treatment

Gonorrhea in particular has become resistant to antibiotic treatment. According to Dr. Teodora Wi, medical officer of human reproduction at the World Health Organization (WHO),8 "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."

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 as well.

In 2013, the U.S. Centers for Disease Control and Prevention (CDC) estimated about one-third of gonorrhea cases were resistant to at least one antibiotic. At the time, treatment guidelines were updated 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.9

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, CDC data published in JAMA in 201510 suggested improvements in susceptibility might turn out to be short-lived, which indeed turned out to be the case. Between 2013 and 2014 alone, cases of antibiotic-resistant gonorrhea suddenly doubled. The CDC now notes that:11

"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."

Drug-Resistant Gonorrhea Is a Global Problem

In the U.K., the first case of gonorrhea resistant to both ceftriaxone and azithromycin was reported this year.12 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,13 "[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."

According to WHO,14 "Currently, in most countries, extended-spectrum cephalosporins 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." 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.

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.

STD Vaccines Are Not the Answer

At present, vaccines are available against HPV, hepatitis A and hepatitis B infection. A number of other vaccines against STDs are also under development, including vaccines against HIV and herpes simplex virus. Last year, researchers reported that a vaccine against meningitis appears to help prevent gonorrhea. While causing different diseases, the bacteria Neisseria gonorrhoeae (which causes gonorrhea) and Neisseria meningitidis (which causes meningococcal disease) are in fact related. As reported by STAT News:15

"The research, conducted in New Zealand, found that the gonorrhea rate among teens and young adults there who had received a meningitis B vaccine during an emergency campaign in the early 2000s was significantly lower than the rate seen in people of the same age who weren't vaccinated.

Researchers in Quebec say they saw the same phenomenon after a meningitis outbreak there, and previously published data from Cuba and Norway also hint of the vaccine's unexpected benefit …

'While it is still very early days, these findings represent a positive step in the search for a vaccine against this common and distressing disease that is increasingly resistant to antibiotic treatment,' said Robin Gaitens, a spokeswoman for GSK, which owns the product that contains this meningitis component."

However, while that may sound like promising news, it's important to realize that vaccines push pathogens to evolve in the same way antibiotics do. As noted by Paul Ewald, an evolutionary biologist at the University of Louisville, "If you don't have these pathogens evolving in response to vaccines, then we really don't understand natural selection." So, ultimately, STD vaccines are not the answer to this growing crisis of drug-resistant STDs.

Deadly Chicken Disease Evolving in Response to Vaccination

Quanta Magazine recounts the research being done on chickens by Andrew Read, a disease ecologist at the Pennsylvania State University Center for Infectious Disease Dynamics:16

"Read and his colleagues are studying how the herpesvirus that causes Marek's disease — a highly contagious, paralyzing and ultimately deadly ailment that costs the chicken industry more than $2 billion a year — might be evolving in response to its vaccine … Marek's disease has been sickening chickens globally for over a century; birds catch it by inhaling dust laden with viral particles shed in other birds' feathers.

The first vaccine was introduced in 1970, when the disease was killing entire flocks. It worked well, but within a decade, the vaccine mysteriously began to fail; outbreaks of Marek's began erupting in flocks of inoculated chickens. A second vaccine was licensed in 1983 in the hopes of solving the problem, yet it, too, gradually stopped working.

Today, the poultry industry is on its third vaccine. It still works, but Read and others are concerned it might one day fail, too — and no fourth-line vaccine is waiting. Worse, in recent decades, the virus has become more deadly The big question is whether the vaccines directly incited these changes or the evolution happened, coincidentally, for other reasons, but Read is pretty sure the vaccines have played a role."

Research Shows Vaccines Can Promote Virulence

In a 2015 study,17 Read's team took 200 chickens and vaccinated half of them against Marek's disease using the current vaccine. All were then infected with Marek pathogens ranging from mild to virulent. Over the course of the birds' lives, the vaccinated birds shed far more of the most virulent strains, while the unvaccinated ones shed far more of the least virulent strains.

In other words, the findings suggest the vaccine actually encourages the proliferation and spread of the most dangerous viral strains, which eventually can lead to a virus capable of evading vaccine-primed immune responses. According to the authors:

"Vaccines that keep hosts alive but still allow transmission could thus allow very virulent strains to circulate in a population. Here we show experimentally that immunization of chickens against Marek's disease virus enhances the fitness of more virulent strains, making it possible for hyperpathogenic strains to transmit.

Immunity elicited by direct vaccination or by maternal vaccination prolongs host survival but does not prevent infection, viral replication or transmission, thus extending the infectious periods of strains otherwise too lethal to persist. Our data show that anti-disease vaccines that do not prevent transmission can create conditions that promote the emergence of pathogen strains that cause more severe disease in unvaccinated host."

A similar situation occurred with the human pertussis (whooping cough) vaccine. Whooping cough is conferred by the Bordetella pertussis bacterium. The old vaccine, which was made with whole killed bacteria, was replaced with an acellular vaccine due to severe side effects. However, the new acellular vaccine, made from outer membrane proteins of the bacterium, quickly waned, triggering global epidemics.

In 2001, researchers proposed the resurgence of whooping cough might be due to the evolution of the bacteria, caused by widespread vaccination.18 In the end, whether we're fighting pathogens using drugs like antibiotics or vaccines, pathogens that aren't killed outright tend to strengthen over time, and we now know there are genetic components that allow pathogens to share genetic resistance material even between different species — a fact that raises the stakes rather significantly.

Prevent STDs Using Safe Sex Practices

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All sexually transmitted diseases, including gonorrhea, can be prevented via safe sex practices, such as being in a mutually monogamous relationship with a partner who does not have gonorrhea, and using condoms. Even if you're in a mutually exclusive relationship, continue using condoms (for all forms of sex: vaginal, anal and oral) until both partners have been tested for STDs and been found clear, and remember that condom use does not prevent all STDs.

Herpes and HPV, for example, can be spread through skin contact even when using a condom. Other prevention methods include19 sexual abstinence (including vaginal, oral and anal), and if being sexually active with more than one partner, get tested and share test results with each other. Last but not least, if you test positive for an STD, make sure you get treatment, and avoid pregnancy until your infection has fully cleared.