A Highly Drug-Resistant Strain of Gonorrhea has been Detected in the U.S-Here's What to Know
Sexually transmitted infections are on the rise. According to the Centers for Disease Control and Prevention, "Reported cases of gonorrhea and primary & secondary (P&S) syphilis were up 10% and 7%, respectively, compared to 2019." But that's not the only troubling trend. Gonorrhea has always been a public health concern, but in recent years has become an urgent threat because the STI is resistant to multiple standard antibiotics. While this has been the case in multiple countries like Japan, Australia, France, Japan, Slovenia, Sweden, the United Kingdom of Great Britain and Northern Ireland, for the first time in the United States, a highly drug-resistant strain of gonorrhea has been detected in Massachusetts. The Massachusetts Department of Public Health said two separate cases were discovered and issued a warning for health officials.
"The discovery of this strain of gonorrhea is a serious public health concern which DPH, the CDC, and other health departments have been vigilant about detecting in the US," said Public Health Commissioner Margret Cooke in a statement. "We urge all sexually active people to be regularly tested for sexually transmitted infections and to consider reducing the number of their sexual partners and increasing their use of condoms when having sex. Clinicians are advised to review the clinical alert and assist with our expanded surveillance efforts."
The situation is alarming, but not shocking to some experts. "We've been waiting for this to happen," Edward Hook, MD, an expert in STIs and professor at the University of Alabama at Birmingham School of Medicine, told CIDRAP News. "Development of antibiotic resistance is an inexorable process for gonorrhea." Dr. Hook explained to the outlet," that this process, which has driven periodic changes to gonorrhea treatment recommendations since the 1960s, is continuing with ceftriaxone. As the amount of ceftriaxone that's needed to stop the growth of N gonorrhoeae—known as the minimum inhibitory concentration (MIC)—rises, it increases the chance of treatment failure." He said, "We've seen this gradual increase in ceftriaxone MICs for gonorrhea occurring over a period of years, but in the last few years we've seen levels where treatment failure begins to be a problem."
Eat This, Not That! Health spoke with Dr. Damian Alagia, Senior Medical Director for Advanced Diagnostics and Women's Health for Quest who explains what to know about gonorrhea and why cases are spiking. As always, please consult your physician for medical advice.
Why There's a Strain of Gonorrhea Resistant to Antibiotics
Dr. Alagia tells us, "According to the Centers for Disease Control and Prevention, almost 700,000 cases of gonorrhea were confirmed in the U.S. in 2021, a 130% increase since 2009. Aside from being so prevalent (the second-most reported STI in the U.S.), gonorrhea continues to evolve, increasing its resistance to available antibiotics. Simply put, the rate of its evolution outpaces the rate at which we can develop new drugs."
The World Health Organization says, "Resistance to so many treatment options, including penicillins, sulphonamides, tetracyclines, quinolones and macrolides (including azithromycin), as well as so-called last line options like cephalosporins, make N. gonorrhoeae a multidrug resistant organism. This resistance is caused by a number of factors, including unrestricted access to antimicrobials, inappropriate selection and overuse of antibiotics, and poor quality antibiotics. Further, genetic mutations within the organism have contributed to increased drug resistance in N. gonorrhoeae. Infections outside of the genital area – namely in the throat and rectum – particularly affect key populations such men who have sex with men. This may also play an important role in the development of resistant strains as N. gonorrhoeae interact and exchange genetic material with other organisms in these parts of the body. "
What to Know About Gonorrhea
Dr. Alagia says, "According to the WHO and CDC, gonorrhea is among the drug-resistant bacteria of greatest public health concern. When left untreated, gonorrhea can cause serious and permanent health problems. What is particularly troubling is that gonorrhea infections are often asymptomatic, especially in women, allowing the bacteria to spread undetected.
Untreated gonorrhea can cause serious and permanent health problems. In women, untreated gonorrhea can cause pelvic inflammatory disease, or PID, which may include complications like chronic pelvic pain, infertility or ectopic pregnancy. In men, gonorrhea can cause a painful condition in the tubes attached to the testicles, which can, in rare cases, lead to infertility. Beyond this, gonorrhea may spread to your blood or joints and increase your chances of getting or giving HIV.
Why STIs are Spiking, Especially Among 55+
Dr. Alagia explains, "According to preliminary data from the CDC, there were 2.5 million reported cases of chlamydia, gonorrhea, and syphilis in 2021. Several factors have contributed to the rise in STIs. We're seeing a failure to provide quality sexual healthcare nationwide, as higher rates disproportionately impact minority groups. Further, much preventative care was delayed during the pandemic, causing concerns about undiagnosed issues and worsening conditions. Additionally, we are not testing enough.
Patients aren't going to doctors to get tested, and primary physicians aren't doing enough testing for sexual health and encounters. This could be due to social anxiety around the stigma of having a STI, as well as lack of healthcare. In addition, people are living to be older than ever before. With the divorce rate and new pharmaceuticals available to treat erectile dysfunction, sexual activity amongst 55+ year-olds has increased. Additionally, seniors don't need to worry about pregnancy, so they may skip protection, leading to a higher risk of STIs."
Gonorrhea Symptoms, Risk Factors and Causes
Dr. Alagia shares, "In many cases, gonorrhea infection shows no symptoms. If you do experience symptoms, it can affect many parts of your body. Most commonly, the genital tract. For men, signs and symptoms could include pain or swelling in one testicle, pus-like discharge, and painful urination. For women, signs and symptoms could include painful urination, abdominal or pelvic pain, vaginal bleeding between periods, and increased vaginal discharge. It can also affect other parts of your body, including the rectum, joints, throat, and eyes. Please see your doctor immediately if you are experiencing troubling signs or symptoms.
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It is often passed from one person to another during sexual contact. Common risk factors of gonorrhea include sexual contact with a person who has gonorrhea, sex with a new partner without protection, and unprotected sex in a high gonorrhea burdened area."
What to Know About STIs and Fertility
Dr. Alagia says, "According to the CDC, chlamydia, and gonorrhea are important preventable causes of pelvic inflammatory disease (PID) and infertility. These infections in the upper genital tract may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, leading to infertility. It's recommended that all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners or a sex partner who has a sexually transmitted infection, should get tested annually.
Knowledge is power. Having an STI can be scary, but most are curable, and catching them early is the best way to protect yourself and others. Just remember these simple steps: S.T.D.
- Start by getting back to care. Most people put off preventive care during the pandemic.
- Test to know if you have an STI. Remember, if sexually active, the only true way to see if you have an STI is to get tested.
- Do get treatment to protect your health and others. Even without symptoms, you can carry and spread an STI, and seeking testing and treatment is not something you need to be intimidated about."
Common Myths About STIs
There's several misconceptions about STI and Dr. Alagia shares the most common.
"Myth #1: No symptoms mean no STI.
The only way to know if you have an STI is to get tested. STIs are often silent and without symptoms. In fact, up to 50% of men and 90% of women with chlamydia don't show symptoms, and about 80% of women with gonorrhea have no symptoms.
Myth #2: I would know if my partner had an STI.
This goes along with myth #1. You usually can't see that someone has an STI – even a doctor can't tell by looking at people. And it's possible your partner may have an STI and not know it. Reminder: people don't always have symptoms.
Myth #3: STIs don't have serious health effects.
While college students may be more focused on pregnancy prevention than starting families, understanding the potential for long-term health effects is important. If left unchecked, STIs like chlamydia and gonorrhea – which are curable with treatment – can lead to pelvic inflammatory disease in women and cause infertility.
Myth #4: If my doctor thought I had an STI, they would have tested me for it.
Not necessarily. Some younger people are uncomfortable or embarrassed to have a frank conversation about their sexual behavior with their doctors, are not honest about their sexual history, and may not understand their STI risk. On the flip side, past research has found gaps in care among doctors, with annual screening guidelines sometimes overlooked, especially if someone doesn't have symptoms.
Myth #5: My partner and I are exclusive, so I don't need to be tested.
If you and your partner have each had sex before, you are both at risk unless you both got tested before you became intimate. According to the CDC, all sexually active women under the age of 25 should be screened once a year for chlamydia and gonorrhea, regardless of the number of sex partners, and all sexually active men who have sex with men should be tested at least once a year for syphilis, chlamydia, and gonorrhea
Myth #6: Getting tested is a hassle—and embarrassing.
Screening for STIs does not have to be daunting or embarrassing. Consumer-initiated testing services like Quest allow people to purchase a test discreetly online, including tests for some of the most common STIs like chlamydia, gonorrhea, and syphilis. You can choose to share results with your doctor or talk with an independent physician about your results to devise a plan that supports your health, including prescription treatment if appropriate. Other options include making an appointment with a primary care doctor or, for females, an OB/GYN, and many colleges have health clinics that may offer STI testing. The CDC also offers resources to find a testing site near you at GetTested.cdc.gov."