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Gonorrhea Is Becoming Untreatable, U.N. Health Officials Warn August 30, 2016 · 5:12 PM ET

REBECCA HERSHER

A microscope image, magnified 600 times, of the bacteria that cause the sexually transmitted disease gonorrhea. BSIP/UIG via Getty Images

We are running out of ways to treat gonorrhea, the World Health Organization

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announced today.

The U.N. health agency released new guidelines warning doctors that it no longer

recommends an entire class of antibiotics, quinolones, because quinolone-resistant

strains of the disease have emerged all over the world.

S H O TS - H E A LT H N E W S

Gonorrhea Evades Antibiotics, Leaving Only One Drug To Treat Disease

Instead, the health agency recommends using cephalosporins, another class of

antibiotic. The new protocol replaces guidelines that had not been changed since

2003.

According to the WHO, 78 million people are infected with gonorrhea every year.

Worldwide, health officials are concerned that overuse of antibiotics for other

infections, such as urinary tract infections, will lead to widespread, untreatable strains

of gonorrhea. In 2011, a super-resistant strain showed up in Japan.

As NPR's Rob Stein has reported:

"Gonorrhea has been plaguing humanity for centuries. But ever since penicillin came

along a dose of antibiotics would usually take care of the disease.

"'Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline and

doxycycline — very commonly used drugs,' said Jonathan Zenilman, who studies

infectious diseases at Johns Hopkins.

"But one by one, each of those antibiotics — and almost every new one that has come

along since — eventually stopped working. One reason is that the bacterium that causes

gonorrhea can mutate quickly to defend itself, Zenilman said.

"'If this was a person, this person would be incredibly creative,' he said. 'The bug has an

incredible ability to adapt and just develop new mechanisms of resisting the impact of

these drugs.'"

The WHO shift to the new class of antibiotics will not fix that overall problem of

bacterial creativity. In some countries, strains of gonorrhea are already resistant to the

newly recommended class of drugs.

The U.S. Centers for Disease Control and Prevention warned back in 2012 that one of

two drugs in the class of antibiotics the WHO now recommends, cephalosporins, was

in danger of becoming useless to treat gonorrhea, at least in the U.S, and

recommended that doctors stop prescribing it.

Since then, the CDC's recommended treatment for gonorrhea has been a dual therapy,

with the two antibiotics ceftriaxone and azithromycin, but an analysis in July warned

that the bacteria could even become resistant to that combination.

S H O TS - H E A LT H N E W S

Despite Rise Of Superbugs, Syphilis Still Has A Kryptonite

As for when antibiotic options will run out altogether, Teodora Wi of the WHO's

Department of Reproductive Health and Research tells the journal Science, "We will

have to have new drugs in 5 years, I think."

The U.S. government is spending millions of dollars through the CDC and National

Institutes of Health to develop new antibiotics and combat resistance.

The WHO also revised its guidelines for treating two other sexually transmitted

infections, chlamydia and syphilis. Neither is facing severe antibiotic resistance.

Syphilis, for example, can be treated with a single dose of penicillin, although there is a

worldwide shortage of the drug.

Although all three sexually transmitted diseases affect both men and women, they can

have particularly devastating effects on women if they are not treated. Gonorrhea can cause pelvic inflammatory disease and lead to dangerous ectopic pregnancies. Syphilis can pass from a pregnant woman to her fetus, and chlamydia can make it difficult for a woman to get pregnant.

stds gonorrhea world health organization

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Gonorrhea Evades Antibiotics, Leaving Only One Drug To Treat Disease

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August 9, 2012 · 3:32 PM ET

Heard on All Things Considered

ROB STEIN

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Health officials say they're worried that one day there will be no more antibiotics left to treat gonorrhea. iStockphoto.com

There's some disturbing news out today about a disease we don't hear about much

these days: gonorrhea. Federal health officials announced that the sexually

transmitted infection is getting dangerously close to being untreatable.

As a result, the federal Centers for Disease Control and Prevention issued new

guidelines for how doctors should treat gonorrhea. The guidelines are designed to

keep one of the remaining effective antibiotics useful for as long as possible by

restricting the use of the other drug that works against the disease.

"We are sounding the alarm," said Gail Bolan, who heads the CDC's division of STD

prevention.

Gonorrhea has been plaguing humanity for centuries. But ever since penicillin came

along a dose of antibiotics would usually take care of the disease.

"Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline and

doxycycline — very commonly used drugs," said Jonathan Zenilman, who studies

infectious diseases at Johns Hopkins.

But one by one, each of those antibiotics — and almost every new one that has come

along since — eventually stopped working. One reason is that the bacterium that

causes gonorrhea can mutate quickly to defend itself, Zenilman said.

"If this was a person, this person would be incredibly creative," he said. "The bug has

an incredible ability to adapt and just develop new mechanisms of resisting the impact

of these drugs."

Another reason is that antibiotics are used way too frequently, giving gonorrhea and

many other nasty germs too many chances to learn how to survive.

"A lot of this is occurring not because of treatment for gonorrhea but overuse for other

infections, such as urinary tract infections, upper respiratory tract infections and so

forth," Zenilman said.

It got to the point recently where doctors had only two antibiotics left that still worked

well against gonorrhea — cefixime and ceftriaxone.

But on Thursday, federal health officials announced that one of their worst fears had

come true: Evidence had emerged that gonorrhea had started to become resistant to

cefixime in the United States.

"We're basically down to one drug, you know, as the most effective treatment for

gonorrhea," Bolan said.

Cefixime and ceftriaxone are in the same class of antibiotics. That means it's only a

matter of time before ceftriaxon goes, too, she says.

"The big worry is that we potentially could have untreatable gonorrhea in the United

States," Bolan said.

That's already happened in other countries. Totally untreatable gonorrhea is popping

up in Asia and Europe.

So the CDC declared that doctors should immediately stop using the cefixime.

"We feel we need to a take a critical step to preserve the last remaining drug we know

is effective to treat gonorrhea," Bolan said.

About 700,000 Americans get gonorrhea every year. If untreated, gonorrhea can cause

serious complications, including infertility and life-threatening ectopic pregnancies.

"I think it should be a real clarion call to every American that we've got a looming

public health crisis on our hands and potentially hundreds of thousands of cases of

untreatable gonorrhea in this country every year," said William Smith, who heads the

National Coalition of STD Directors.

Officials know adopting the new guidelines won't be easy. For one thing, ceftriaxone is an intra-muscular shot instead of a pill. And they want doctors to give it along with at least one other antibiotic and test patients to make sure they're cured.

But they know that all this will help only for a while, and that they can't stop the clock from ticking on the one drug left.

"We think it's only a matter of time based on the history of this organism until resistance does develop," Bolan said.

So scientists are searching for new combinations of antibiotics that might work. And officials are pushing for new weapons that might stay one step ahead of gonorrhea and the growing list of antibiotic-resistant infections.

stds gonorrhea antibiotic resistance infectious disease