By show of hands, how many people winced or involuntarily crossed their legs reading that title? My hand is raised, too.
Back when I took Health Class in High School chlamydia, syphilis, and gonorrhea were part of the “curable sexually transmitted diseases” list. While still terrifying to think about, they were less terrifying to the impressionable youth in comparison to, say, herpes or HIV. Those were a life sentence. Contraction of these bacterial infections by contrast, in theory, meant an awkward conversation with your partner, a trip to the doctor, a course of antibiotics, and Bob’s Your Uncle!
However this is not really the case anymore. We are two minutes from midnight in our fight against antibiotic resistant gonorrhea.
Indeed gonorrhea has a long and torrid history of playing footsie between “curable” and “incurable.” The inception of antibiotic use against gonorrhea dates back to the late Depression Era when sulfonamides (sulfas) began being used as treatment.7 Unfortunately it was short-lived and within a decade sulfa-resistant strains were widespread. As luck would have it, in 1942 penicillin had just begun its mass production as the “wonder drug.” While incredibly important for the War Effort against bacterial pneumonia, penicillin also quickly took over as the treatment of choice for gonorrhea.
As the years went on, higher and higher doses of penicillin were needed until a penicillin resistant strain was discovered in the 1980s. Concurrently other antibiotics had come and gone as well, including tetracycline, which was also rendered useless by the 1980s. The fluoroquinolones (ciprofloxacin) remained a recommended treatment in the United States from 1993 until the late 2000s when fluoroquinolone-resistant gonorrhea was prevalent enough that the antibiotic was removed from the market. With the availability of rapid tests, the need for growing cultures went out the window, and with it the ability to simultaneously test for antibiotic resistance. Consequently many people would swallow down their antibiotics, mistakenly think they were cured, and would go on to infect their next partner with their particularly invulnerable strain of gonorrhea. A (frighteningly) perfect marriage of ‘Throwing the Baby Out with the Bathwater’ and ‘Law of Unintended Consequences.’
As it stands, the curability of gonorrhea is hanging on literally by a single thread – combination treatment of injectable ceftriaxone and azithromycin – but even that may not last forever. CDC labs have found azithromycin resistance has increased from 1% to 4% since 2013.6 Earlier this year there was even a case of “super gonorrhea” seen in man from the U.K after a liaison with a lady in Southeast Asia. Thankfully the poor chap was eventually able to find a treatment, but still!2,3 Way too close to the minute hand striking midnight.
For the fourth straight year cases of “curable” sexually transmitted diseases have been on the rise according to the CDC, including gonorrhea, chlamydia, and syphilis.6 Gonorrhea alone has seen a 67% increase in cases across the board, syphilis has increased 76% (70% of cases where the sex of the partner is known have been in the LBGTQ community), and chlamydia still holds its place at the top of the list of most commonly reported STIs. Of the 1.7 million cases in 2017, 45% were high school and college age people.
Gonorrhea is particularly good at transforming itself to survive in the face of the antibiotic warfare we wage against it; couple that with the sexual milieu of today’s academia, and it should come as no surprise that we find ourselves in this situation. The ubiquitous hook-up culture, strong in its pursuit of sexual liberation and moral inhibition, flies in the face of good sense when it comes to protecting your body. While not calling for a harkening back to puritanical law, perhaps there should be teensy bit more consideration of how much risk you really are at when casually hooking up? And by teensy, I mean a lot…
In this post-slut-shaming era, it’s one thing to say shame-free-sex, it’s another when you realize how much of that sex is also protection-free sex. According to a CDC statistics asking the surveyed how often they used a condom during sexual encounters in the past year, only 14.8% and 19% respectively of women and men ages 15-44 reported using one every time.1 Granted, many people are married in their 30s and 40s, so condom use logically drops off the map when monogamy and intentional baby-making comes into the game. So let’s exclude those groups for the sake of the argument. Among 15-19 year olds, that stat is around 35.6%; people 20-24 years old were half as likely (17.9%) to use a condom every time. HALF! It’s no wonder this is the most susceptible group!
The flagrant disregard for one’s self-preservation is cringe-worthy when you see Instagram posts from universities across the country on showing people making sexually competitive and innuendo-filled “To-Do” lists and post-coital ‘apology cakes’ featuring an icing-scribed mea culpa over giving someone an STD. Getting an STD is becoming a joke when really it’s anything but. What else did we expect when sexual liberation (and often alcohol-induced, consequence-be-damned attitude) is combined with liberation from consequence with just a tiny pill (or a shot)?
While we are teetering on the edge, an article in Wired Magazine published last week does point out that perhaps there is a faint light at the end of the tunnel.5 The drug zoliflodacin has just finished its very promising Phase 2 trials. It will still have to clear Phase 3 and FDA approval, but hopefully it will be cleared by the time the current ceftriaxone/azithromycin cocktail goes the way of the Dodo. However, it is likely to be expensive the article points out. With a large R&D bill and marketed use for gonorrhea only, it is likely to be much more costly for the consumer than today’s treatment.
But in the incessant fight for sexual freedom still raging on today in our social climate, we should remember that nothing is ever free and the proverbial butcher’s bill has to be paid one way or another. Let’s hope it’s not the way that ends in “super gonorrhea.”
Despite how it sounds, this article is not meant to judge the choice to sleep with whomever you like; it’s your life and certainly not my place to judge your choices, however ill advised they are. What I am judging is the unmitigated naïveté of those who consistently fail to use protection, either by choice, wanton disregard, or inebriation, and unwittingly spread antibiotic-resistant bacteria.
Like your Mom (probably) told you: When you sleep with someone, you’re sleeping with all the people who came before you – and there’s a good chance one of them, one hook-up somewhere along that circuitous path to you, probably had an STI.
Remember folks, if you’re going to live a promiscuous life, you should definitely care of yourself and your body! And probably extra protection with you to your next dalliance. Because no one wants to wake up to find they have antibiotic-resistant gonorrhea.
1Copen, C. E. (2017). Condom Use During Sexual Intercourse Among Women and Men Aged 15–44 in the United States: 2011–2015 National Survey of Family Growth. National Health Statistics Reports,105, 1-18. Retrieved December 03, 2018, from https://www.cdc.gov/nchs/data/nhsr/nhsr105.pdf.
2Gallagher, J. (2015, September 18). ‘Super-gonorrhoea’ outbreak in Leeds. Retrieved from https://www.bbc.com/news/health-34269315
3Gallagher, J. (2018, April 20). ‘World’s worst’ super-gonorrhoea man cured. Retrieved from https://www.bbc.com/news/health-43840505
4Gonorrhea. (2018, March 28). Retrieved from https://www.cdc.gov/std/gonorrhea/arg/basic.htm
5McKenna, M. (2018, November 28). Cheap and Easy STD Treatment Is Over. What Went Wrong? Retrieved from https://www.wired.com/story/gonorrhea-syphilis-easy-std-treatment-is-over/
6NCHHSTP Newsroom. (2018, August 28). Retrieved from https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html
7Unemo, M., & Shafer, W. M. (2011). Antibiotic resistance in Neisseria gonorrhoeae: Origin, evolution, and lessons learned for the future. Annals of the New York Academy of Sciences,1230(1). doi:10.1111/j.1749-6632.2011.06215.x