How Worried Should You Actually Be About Drug-Resistant Gonorrhea?

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You may have heard recently that drug-resistant gonorrhea is out there, which is sufficiently terrifying news. That news comes courtesy of the World Health Organization, which released a report last week stating that the sexually transmitted infection is on the rise around the world, including cases that are resistant to antibiotics.

In case you’re unfamiliar with antibiotic resistance, it’s what happens when an antibiotic has lost the ability to stop or kill bacterial growth, making the bacteria “resistant” to the drug. While that might sound like the plot of a new dystopian horror movie, the concept of antibiotic-resistant gonorrhea is actually a little more complicated (and slightly less terrifying) than it sounds.

There aren’t actually people walking around with incurable gonorrhea.

The definition of “untreatable gonorrhea” varies somewhat from country to country, as there isn’t a standard protocol for verifying and reporting treatment failures, Brian Katzowitz, health communication specialist with the CDC, tells SELF. Studies that test for antibiotic resistance to gonorrhea are mostly done with lab samples of gonorrhea isolates so that researchers can test a sample against specific drugs and see how much of the drug they need to stop growth of the bacteria. If it takes more of a drug to combat a particular gonorrhea isolate, that would show increasing resistance to that drug.

The report specifically states that WHO has found “widespread resistance to older and cheaper antibiotics,” noting that some countries, especially high-income ones where STI surveillance is good, are finding cases of gonorrhea isolates that are untreatable by “all known antibiotics.” This doesn’t mean that these antibiotics won’t work on the infections—just that they’re seeing them become less effective, either in a lab setting or on the first course of treatment.

“There have been a only a few cases, all of which are outside of the U.S., where a patient has not had their infection cured with ceftriaxone (part of the currently recommended dual therapy in the U.S.),” Elizabeth Torrone, Ph.D., M.S.P.H., an epidemiologist in the CDC’s Division of STD Prevention, tells SELF. “In these rare cases, the patients were eventually treated successfully, but the initial treatment failure suggests that resistance to cephalosporins like ceftriaxone is on the horizon.”

Last year, WHO updated their global treatment recommendations to suggest doctors treat gonorrhea with a combination of two antibiotics: ceftriaxone and azithromycin.

Torrone says that combination therapy is still effective at curing gonorrhea. “To date, no treatment failures have been reported in the United States,” she says. “But signs of emerging resistance to azithromycin suggests that this drug will be next in the long line of antibiotics to which gonorrhea bacteria have become resistant.”

According to the CDC , gonorrhea is the second most commonly reported notifiable disease in the U.S. In 2015, the most recent year for which data is available, 395,216 cases of gonorrhea were reported in the U.S. Gonorrhea is especially concerning for women, since it can cause tubal infertility , ectopic pregnancy (where a pregnancy progresses outside the uterus), and chronic pelvic pain. Even scarier: gonorrhea often has no symptoms. When symptoms do appear, they can manifest as pain during urination, increased vaginal discharge, bleeding between periods, pain during sex, and pelvic pain, according to the Mayo Clinic .

But just because we can treat it now doesn’t mean that emerging antibiotic resistance is not a very big deal.

“History tells us that resistance to the current antibiotics will develop,” Dr. Torrone says. Doctors who aren’t well informed about the best way to treat the STI can accidentally speed up antibiotic resistance in gonorrhea if they treat it with azithromycin alone, she says. “Dual therapy helps prevent the development of resistance and it is currently the only recommended treatment for gonorrhea.”

In the WHO report, the organization urges the medical community to come up with new drugs to treat the STI. Currently, only three drugs are in research and development, WHO says, which makes the pipeline “relatively empty.”

If you do test positive for gonorrhea, don’t panic. There are a few things you can do to make sure you’re not contributing to antibiotic resistance.

First, make sure your doctor gives you a prescription for azithromycin and ceftriaxone—not one or the other, or something totally different. Make sure to take your medication as prescribed, which includes taking the full course of antibiotics, even if your symptoms start to clear up, Amesh A. Adalja, M.D., senior associate at the John’s Hopkins Center for Health Security, tells SELF

If you still have symptoms after you’ve undergone the full treatment, let your doctor know. It’s possible you may need another dose of antibiotics, says Dr. Adalja. But it’s also possible that you could have a complication related to the STI (like disseminated gonorrhea or pelvic inflammatory disease) or that you were reinfected by a partner who wasn’t properly treated. And because this STI is usually symptomless, the CDC recommends retesting for the infection three months after treatment, just to make sure it’s gone.

If you’re not sure if you need to be tested for gonorrhea, ask your doctor. The CDC recommends annual gonorrhea screening for all sexually active women under 25, as well as women 25 and over who have new or multiple sex partners. Some doctors don’t routinely screen patients for all STIs, so it’s on you to speak up and ask. And to prevent your risk of acquiring gonorrhea in the first place, use condoms or dental dams during sex, and make sure you and your partners are getting tested for STIs regularly.

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