These days, sexually transmitted infections (STIs) are pretty much a fact of life: the American Sexual Health Association reports that more than half of all people will have some kind of STI at some point in their lifetime. And thanks to frequently asymptomatic infections like herpes and HPV, many sex-havers carry on blissfully unaware of the things they’ve picked up from friends—especially since less than one third of physicians routinely screen their patients for such infections.
So unless you’ve regularly gotten tested for everything since the dawn of your sexual maturity and received a squeaky clean bill of health every time, chances are good you’ve gotten (or got) something or other. And that’s really okay: most STIs are no big deal if they’re treated. Even the incurable herpes goes totally unnoticed in most patients. And HIV, once a death sentence, is now so well managed that many live with viral loads so low as to make transmission to a partner nearly impossible.
But just as a lack of polio and smallpox patients in the U.S. doesn’t mean we’ve outgrown vaccines, the increasingly great treatment and destigmatization of STIs doesn’t mean we can forget they exist. Last week, the World Health Organization (WHO) made that message loud and clear in a press release. According to their statement, data from 77 countries has shown that gonorrhea—a sexually transmitted infection afflicting some 78 million people a year—is increasingly evolving resistance to antibiotics.
This crisis has been building at a slow boil for years now. Back in 2015, a study reported that attempts to curb the increasing resistance of Neisseria gonorrhoeae to standard antibiotic treatment seemed to be failing: researchers studied samples of the bacteria taken throughout the years and saw that the antibiotic ceftriaxone became increasingly less effective as its popularity grew. This is a problem doctors face with all antibiotics—as soon as they’re used, bacteria encounter them and start to evolve defenses. The more a drug interacts with bacteria out in the world, the more quickly resistance will spread. That’s why you’re not supposed to harass your doctor for antibiotics when you’ve got an annoying cold; if we limit antibiotic use and save it for when it’s really needed, we can stave off the inevitable expiration of a drug’s effectiveness.
Illustration of Neisseria gonorrhoeae
In 2013, the Centers for Disease Control and Prevention classified gonorrhea as an “urgent threat” and recommended treating it with a one-two punch of ceftriaxone and another drug. That lowered resistance for a time, according to the 2015 study, but then resistant strains started to become more common again.
“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,” WHO medical officer Teodora Wi said in a statement. “These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhea is actually more common.”
What can we do?
The WHO is calling for new antibiotics to add to our line of defense. Unfortunately, they report that only three such drugs are in any stage of development. Antibiotics, the press release points out, are not a big moneymaker for pharmaceutical companies: there’s the fact that people only take them for a short time, and the fact that doctors are actually told to prescribe them as infrequently as possible. If you’re putting millions or billions of dollars into the development of a drug, knowing that the whole point is to limit its sale is a tough pill to swallow.
But even if all three of these new antibiotics make it to market, the problem won’t go away. Antibiotic resistance is on the rise, and so are deadly superbugs we can’t hope to treat with our current arsenal of drugs. As long as we continue to rely on antibiotics, they’ll keep losing their efficacy. In the long run, scientists are going to have to figure out other ways of treating bacterial infection—and they’re working on it. Eventually, the WHO hopes a vaccine can nip gonorrhea in the bud for good.
What can I do?
STIs may not be a big deal, but no one wants to get antibiotic resistant gonorrhea. Some doctors are blaming a rise in unprotected oral sex on gonorrhea’s increased resistance to antibiotics, but that’s just one of many factors. Yes, unprotected oral sex can lead to gonorrhea of the throat—it’s usually found in the genitals, but it can make a happy home in the mouth or rectum, too—and those infections are likely to go unnoticed. If your doctor assumes you have strep and gives you antibiotics that aren’t quite right for your throat STI, that could contribute to Neisseria gonorrhoeae‘s ability to resist those drugs. If you want to do your part to stop this particular avenue of bacterial infiltration, use a condom during oral sex. Barring that, you can always insist that a doctor give you a strep test before prescribing you antibiotics for strep throat. Which you should be doing anyway, dumb dumb. If you’ve got a gnarly throat infection and your strep test comes up negative—and you’ve been honest about your sexual activity, which you always should be at the doctor’s office—they’ll probably start to have their suspicions and order the proper test to get you the proper antibiotics.
Being stingy about your antibiotic use is always a safe bet; listen to your doctor, but don’t accept (or demand) antibiotics if they haven’t even determined that you’ve got a bacterial infection.
But luckily, throat gonorrhea doesn’t even have to be a thing. Listen close, kids: get tested for STIs. Like, more than you think you need to be tested. Google your city’s free clinic, find your nearest Planned Parenthood, get up the nerve to ask your regular doctor during your next check-up, order a kit online, whatever. Get yourself tested. Then, with the confidence of someone who’s super in the sexual health know, make sure all your partners are also getting tested. Too embarrassed to ask? Sorry, no unprotected oral sex for you! Them’s the breaks.
As with any STI, the only way to reduce transmission is to also reduce stigma. People shouldn’t be afraid to get tested—that’s how you end up running around blissfully unaware of the Neisseria gonorrhoeae breeding in your throat—and they shouldn’t feel any shame in telling their partners. Knowledge is power, and honesty helps keep other people from picking up what you’re putting down.