Antibiotic resistant gonorrhea and the future of oral sex

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If you haven't previously used condoms and dental dams for oral sex, it might be time to start seriously thinking about that as a safer sex option. Gonorrhea, like other bacteria, has, over the years, developed resistance to the antibiotics used to treat it. Now, it's looking like the last line of cheap and easy defense is crumbling. In particular, this news could change the outlook for certain oral gonorrhea infections. Brian Alexander at MSNBC offers a particularly clear and cogent explanation of what's changed:

For several years, public health officials have been concerned that gonorrhea, one of the most prevalent STDs in the world, might become resistant to the last widely available antibiotics used to treat it, a class of drugs called cephalosporins.

Now, it has.

The percentage of U.S. gonorrhea cases that are resistant to the two cephalosporins used to treat it, cefixime, taken orally, and ceftriaxone, injected, is on the rise, according to the Centers for Disease Control and Prevention's latest Morbidity and Mortality Weekly Report.

The Gonococcal Isolate Surveillance Project, a lookout program designed to spot resistance, found that 1.4 percent of patient samples showed growing ability to defeat cefixime in 2010 compared to just .2 percent in 2000. Resistance to ceftiaxone grew from .1 percent to .3 percent during the same period.

Then Sunday, a Japanese-European team presenting data at the International Society for Sexually Transmitted Disease Research meeting in Quebec City, Canada, publicly announced the discovery of a new strain of gonorrhea, H041, that displays a strong resistance to ceftriaxone.

Oral cases of gonorrhea get special attention because that H041 strain is particularly resistant to ceftriaxone, which, Alexander says, is the only form of cephalosporin used to treat gonorrhea infections of the pharynx. In fact, H041 is 4- to 8-fold more resistant than any previously identified strain.

Although this sounds pretty panic-inducing, it shouldn't be, yet. We aren't talking about an incurable strain. Gonorreah is still treatable—this resistance just means it will be harder to treat, more expensive to treat, and is likely to involve more side-effects from higher doses of antibiotics. But it should be concerning, both from a public health perspective and a personal health perspective. If gonorreah is going to be harder to treat in the future—and it looks like it will be—then preventing infection matters more.

(Thanks, Antinous!)

Image: AIDS awareness - condom use, a Creative Commons Attribution Share-Alike (2.0) image from 47108884@N07's photostream

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  1. n f th bst blwjbs vr hd ws shthd, bt sh ws prfssnl wth rr snstvty. n gnrl th lssn s srly t vd sknky slts.

    1. Fraac,

      I disemvowled your comment. For future reference, I don’t take kindly to misogyny. If you want to pretend that women are the only humans who spread STI’s, do it elsewhere.

      1. Maggie, I think it’s reasonable to suppose that women are the only humans whom fraac feels in danger of getting STIs from. From this point of view, his/her comment is merely a little self-centered.

        I’m not saying that you are forbidden from taking more offense than was intended, but I think you should do so in the knowledge that that’s what you’re doing.

        1. ‘I’m not saying that you are forbidden from taking more offense than was intended, but I think you should do so in the knowledge that that’s what you’re doing.’

          Shorter Creperie: ‘I’m saying you are forbidden to take offense (while prefacing it by denying that’s what I’m saying), and YOU ARE OVERREACTING AND BEING A HYSTERICAL WOMAN!’ /concern trolling

          http://www.derailingfordummies.com/#sensitive

          ‘Skanky sluts’ is misogynist, slut-shaming language. It is offensive and deserved to be disemvoweled.

          1. Haven’t you heard? The world is divided into clean girls and dirty girls, who groom and dress accordingly for easy identification.

            The funny thing is, sexually active men and women are quite likely to use protection. Your squeaky clean prom date might not be so fastidious after a couple of Zimas.

          2. ‘Skanky sluts’ is […] slut-shaming language. It is offensive and deserved to be disemvoweled.

            I don’t disagree (and it was perhaps needlessly provocative of me not to make that clear). I was just annoyed that Maggie had made this into

            […]you want to pretend that women are the only humans who spread STI’s […]

            which I *don’t* think was a fair criticism, for the reasons I gave.

      2. Maggie, I certainly intended no misoogyny, however women are the only humans whose mouths I want parts of me in.

        1. I hesitate to ask, but what about non-humans?

          And, dude, “slut” is offensive. You really didn’t intend any offense, say you’re sorry and let it go.

  2. Nature, this is bullshit. Just ONE FREAKING TIME could you link the disease/cancer/syndrome to the things we DON’T want to do?

    “Hey, Billy, what are you doing?”
    “Why, I’m watching paint dry.”
    “No! That’s very dangerous! You’ll get shin splints and your eardrums will spontaneously perforate! Come have sex with me instead, it’s much safer.”
    “Oh, okay, I’ll do it for safety.”

    1. Allow me to propose a more general form of the theorem: The enjoyment gained from putting anything into any orifice present on you or your partner is inversely proportional to the health benefits thereof.

      So forget the steak, wine, spliff, and cunnilingus, and get back to work!

      1. Except…reproduction.

        It’s not that nature is puritanical, it’s that parasites are wise enough to get associated with fun times.

    2. > …to the things we DON’T want to do?

      Okay, here is the right place to put it. But that’s boo-ooring. Just around the corner there’s an alternative place: its painful for the owner, kinda stinky and rather too tight. Ah, wait, wait, up the other end, this one has teeth! They eat through it and they breathe through it. Perfect!

      Eeew. Well if both of you are happy, or one of you is getting paid enough, then fine. But you don’t get the pox with sudoku…

  3. More poorly understood science from the main-stream media! This is old news. Rocephin still works, and you probably still have a very good shot with azithromycin, cipro or even doxycyline. And – I know this is silly, but you could inspect your partner before having sex with them. In males, gonorrhea almost always produces a whitish discharge that you can see by gently squeezing the urethra from the base up. You may also notice that the urinary meatus may be reddened. In females, there may also be a discharge from the vagina and the vulva may be reddened. In either sex, rectal gonorrhea will produce a lot of gas and mucus. Any unusual odors may also be a reason to hesitate. You might also consider post-exposure prophylaxis. There’s no data, but you could try gargling with a mouthwash that contains hydrogen peroxide. Worth a shot, anyway. In any event, don’t freak out, it’s still treatable. Just be sensible and get yourself treated and you’ll be fine.

    1. You have successfully made the pizza I was nomming on totally unappealing with that thorough, sensible & yet unexpected description.

  4. So, I’m just interpreting the sign you have helpfully included. It seems to be saying “Carrying around a condom just to tap some green, diseased ass is a huge burden. Why not just use this hole over here instead?”

  5. No, it just means be picky about who you have sex with (as it should always be anyway). Don’t go down on someone who is a total stranger, who sleeps with lots of other people, or who has the personal hygiene of a troll.

    1. On the other hand, people who are promiscuous and not in denial about it tend to be much more knowledgeable about STIs and get tested more often. How many monogamous people ever get a full range of STI tests if they don’t have any symptoms? Doctors are more willing to test you, and more likely to suggest it even, if you’re considered “high risk.”

    2. No, it just means be picky about who you have sex with (as it should always be anyway). Don’t go down on someone who is a total stranger, who sleeps with lots of other people, or who has the personal hygiene of a troll.

      You have just rolled back a quarter century of understanding in the prevention of infectious diseases. Villains do not all twirl their moustaches. Criminals don’t all look shifty. That perfectly scrubbed lady or gentleman who claims to be practically a virgin is just as likely to have a venereal disease as the person that you view as unsavory. You can’t tell anyone’s lifestyle or history from looking at them or a having a conversation.

      1. That perfectly scrubbed lady or gentleman who claims to be practically a virgin is just as likely to have a venereal disease as the person that you view as unsavory. You can’t tell anyone’s lifestyle or history from looking at them or a having a conversation.

        That perfectly scrubbed lady or gentleman *may* have a venereal disease: sure, no argument. S/he “is just as likely to”: do you have data to back that up? I want to see figures, just once, before I’ll accept put-downs like “have rolled back a quarter of a century of understanding” in lieu of reasoned argument.

        1. The statement “This creepy-looking person has an STD” is backed by the same amount of evidence as the statement “That clean-cut person has an STD,” namely, zero evidence.

          1. Huh? If I have safe sex with someone who’s informed about STDs and has the proper access to preventative measures, as well as an interest in his or her health and the health of others, my likelihood of contracting STDs goes down; if I have unsafe sex with someone who isn’t informed about STDs and doesn’t have access to prevention, and doesn’t care about his or her health or the health of others, my likelihood of contracting STDs goes up. To a large degree these things are a product of education, which is, sadly in America, tied to class and wealth, and these things are observable factors, by and large. The idea that any partner is equally likely to have STDs regardless of education, class, background, habits, etc. is wholly false.

            So it’s indeed likely that that well-groomed person has at least a modicum of knowledge about prevention and the means to secure it; the proverbial toothless crackhead, not so much. “One never knows,” sure, but there are reasonable ways to make informed choices.

          2. Common sense does not equal truth. The “Well, he looks clean” method of venereal disease prevention is a factor in the spread of such diseases. All of this ‘conventional wisdom’ was deprecated in the 1980s in favor of universal precautions. In the absence of lab results and/or an unassailable ability to trust your sex partner’s history, unsafe sex remains unsafe sex. Anything else is not an informed choice; it’s a guess based on social assumptions.

          3. Once again, Antinous speaks true. My clean-looking highly-educated brother thought someone else looked clean sometime back in the 80s, and they were both dead by 1992.

            One can certainly play the odds, and probably get away with it for some time, but even a slight risk of catching something (so far) incurable, and often lethal, puts quite a damper on the dice-roll, if you ask me.

          4. When I was a kid I concluded the benefits of sex without a condom could not possibly outweigh the risks. Time and the news have only reinforced that conclusion. People tell me unprotected sex is fun, but I’m not a gamblin’ man by habit or inclination.

            I will say, though, that casual sex in general seems like a terribly risky activity. Even with protection, you’re still placing yourself in a vulnerable position with someone you don’t know well. I like most people, but my default state is not to trust until I observe good reason. Why not spend a month or two getting to know a partner before sleeping with them? Then there’s no need to asses the book by its cover.

          5. “casual sex in general seems like a terribly risky activity”

            Yes it is. But so is travelling abroad; driving on backroads; drinking; doing drugs; staying out late; sailing; scuba diving; and well, changing jobs is pretty risky too.

            ” Why not spend a month or two getting to know a partner before sleeping with them?”

            Because it’s boring.

          6. Hm, traveling abroad… kind of depends on what “abroad” is for you. The murder rate in the US is absurdly high compared to just about every other industrialized nation. If you’re talking about (a good part of) South America or some African countries though…

          7. True, but travel is still inherently dangerous, as you’re in places you don’t know very well, you’re moving around a lot, and relying on strangers a lot. I’ve travelled a lot and love it. But I’d still add it to the list of things that are “not exactly safe,” along with casual sex.

          8. Yes it is. But so is travelling abroad; driving on backroads; drinking; doing drugs; staying out late; sailing; scuba diving; and well, changing jobs is pretty risky too.

            Touché, quicksand, touché. Although my point still stands with all but traveling abroad, since that’s the only one where you’re at a comparable level of risk from relative strangers.

            If I was inclined to have sex with partners I wasn’t first friends with, I’d probably be less willing to eschew that risk. I prefer quality of intimacy over quantity, though.

            I wonder what the appeal of intimacy with strangers is for people who desire such. Thoughts?

          9. I can’t speak for the rest of the human race but for me it’s not about ‘intimacy with strangers’ – it’s neither about “intimacy” nor the risk-factor associated with “strangers”. Casual sex occurs in spite of the risk, not because of it. It’s about the thrill of sexual attraction, and the electric appeal of someone new and exciting.

            I think for me it’s always been a combination of being a highly sexual person, and not very risk-averse (ie I didn’t pay much attention to the risk as opposed to seeking it). At least that’s how it was in the past. I’m less so these days – someone who’s a bit more cautious. This article has made me think I might go get tested.

          10. Why not spend a month or two getting to know a partner before sleeping with them?

            Nothing sucks more than spending a ton of energy and time figuring out if you are culturally/socially/psychologically/mentally compatible only to find out you’re sexually incompatible.

            And, even if you know them for a month or two, you still don’t know if they’re going to sleep with someone else or that they don’t already have a disease they don’t know about or the tests you’ve done are before the incubation rate of the disease they picked up right before they started ‘dating’ you.

            And finally, not taking a relationship to the next level means that even for the monogamous, they’re totally allowed to date other people. If they sleep with someone else and they are monogamous, then they will break up with you.

          11. Nothing sucks more than spending a ton of energy and time figuring out if you are culturally/socially/psychologically/mentally compatible only to find out you’re sexually incompatible.

            Actually, sounds like a great way to end up with a good friend.

            And, even if you know them for a month or two, you still don’t know if they’re going to sleep with someone else or that they don’t already have a disease they don’t know about or the tests you’ve done are before the incubation rate of the disease they picked up right before they started ‘dating’ you.

            Granted, there are no guarantees, hence the value to a condom in any event. But, unlike superficial profiling, getting to know someone allows you to make an informed decision about their own attitude about STDs, such as whether they get tested regularly and whether they are careful about whom they sleep with.

            And finally, not taking a relationship to the next level means that even for the monogamous, they’re totally allowed to date other people. If they sleep with someone else and they are monogamous, then they will break up with you.

            In the sense that they won’t date you, sure. But you could still wind up with a friend. And I never said you should only date one person at a time; just be honest about it and, if you want romantic exclusivity, ask.

            I don’t mean to sound sanctimonious. I just find that sex is much more fulfilling with someone I’ve gotten to know and still like. To each their own. And I can understand that not everyone who sleeps with a potential mate relatively early does it for the same reasons.

          12. Nothing sucks more than spending a ton of energy and time figuring out if you are culturally/socially/psychologically/mentally compatible only to find out you’re sexually incompatible.

            What does ‘sexually incompatible’ mean? In my experience if people have honest interaction then sex will be lovely, and it is only not lovely when they aren’t communicating honestly. If I’m compatible with a girl I can’t imagine a scenario where she won’t love my cock. Confused.

          13. That’s correct up until a point. But if those “universal precautions” fail, like a condom breaking, then you’d statistically be better off having had broken that condom, say, with someone from the upper middle class in a developed country, and not, say, someone from the ghettos of a large city in sub-Saharan Africa. Some of these factors are observable, and it’s reasonable that you’d factor those in when making a decision to sleep with somebody or not. This is not to say that all upper middle class folks are free from STDs, or that all crackheads have AIDS, etc., and I’d appreciate these absurd positions not being brought to the table via unhelpful hypotheticals like the clean/dirty girl example you cite above. Are some millionaires intravenous drug users? Sure. Does everyone south of the Sahara in Africa have AIDS? No. Can one reasonably take into account observable lifestyle factors when determining to have safe sex? Of course. That’s all I’m saying, and it’s rather unobjectionable.

          14. The idea that any partner is equally likely to have STDs regardless of education, class, background, habits, etc. is wholly false.

            In 2009, ten Illinois counties reported greater than 30% of their population over the age of 25 had attained a Bachelor degree or better. There were ten counties that reported fewer than 12% of their population had achieved the same. [source: US Census Bureau]

            The first group of counties averaged 98 cases of gonorrhea per 100,000. The second group of counties averaged 67 cases per 100,000. [source: Illinois Department of Public Health].

            You’ve just forgotten what a great place college is to earn your STD.

      2. “You can’t tell anyone’s lifestyle or history from looking at them or a having a conversation.”

        No, you certainly wouldn’t want to be so shallow as to observe or talk to someone whose genitals you might tongue.

  6. I prefer Saran Wrap to dental dams.

    Happy 50th anniversary of the sexual revolution everyone.

    1. Saran wrap… Hm. It isn’t made to the same standards, but it’s easily available (including to kids too young to feel comfortable buying prophylactics) and certainly better than nothing, and I think I can see why some might prefer it.

      1. I’ve actually used dental dams before. Besides the difficulty of getting them (it may be easier now, some years later) they were too small to cover the, ah, topic. Kitchen wrap would have been superior.

  7. Just trying to figure out why the Intelligent Designer decided to make a new strain of gono. Or, alternatively, why the Intelligent Designer allowed humans to develop the antibiotics in the first place.

    1. Monogamy ROCKS.

      Does having one sexual partner at a time prevent STDs? I had no idea! I’m rather confused by all the serial monogamous people with STDs though.

      1. Monogamy reduces rate of propagation of diseases through the population, and (assuming you’re both monogamous) once you know your both clean you’re likely to stay that way. So long-term monogamy can be a pretty good defense both individual and at a “herd immunity” level.

      2. No of course not but limiting yourself to a single partner for your entire life (presuming they follow the same standard) certainly would reduce the chances of getting additional STD’s. Sure you can get whatever they have when you first hookup but that should be it less someone gets something from a toilet. The point is one partner for life will reduce your chances of getting STD’s significantly and even more so the chances of getting a new strain of an STD.

  8. I’ve long wondered why other famously promiscuous animals (dolphins, bonobo, etc.) are not as prone to sexually-transmitted diseases. Are we just not seeing/looking?

    1. Most animals don’t live as long as we do, so STDs don’t have as long to develop all their side effects… and as with all diseases, most animals aren’t travelling as much of the world as we do, and local populations develop local immunities/tolerances/compromises with disease.

      Remember, there’s some evidence that HIV is a crossover from another species.

    2. You rarely hear about any diseases in animals, unless they have become threats to industry or an endangered species. But they are definitely there. Even single-celled animals have sexually-transmitted diseases – look up mate-killer paramecia if you are interested.

        1. Two down? We’ve undoubtedly eliminated many diseases, usually through the effective means of exterminating their host species.

  9. well then no more oral sex for me i guess. oral sex with a condom is even worse than regular sex with a condom

  10. What the….? Cunnilungus is one of my favorite pastimes… Can’t diseases go and ruin something else like… religion?

  11. Nature, this is bullshit. Just ONE FREAKING TIME could you link the disease/cancer/syndrome to the things we DON’T want to do?

    Dare to dream big, man. Like… “Argh! Why can’t blowjobs cure drug resistant strains of gonorrhea???”

    1. Dare to dream big, man. Like… “Argh! Why can’t blowjobs cure drug resistant strains of gonorrhea???”

      “He’s dead, Jim.”
      “But, why, Bones? Why?
      “If I may, Captain. It’s a logical consequence of what your Earth scientists call ‘natural selection.’ There was simply no one on board the Enterprise who would have been pleased to give Lt. Rotehemd a blowjob.”

  12. “….experts stressed that it’s too soon to panic.”

    personally i like to panic at the earliest possible moment.

  13. Then there was the man who had sex with his parrot, and was diagnosed with a bad case of chirpies.

    The worst part is, it’s un-tweetable.

  14. Very troubling given that gonorrhea often doesn’t present any symptoms.

    In my experience, dental dams are not a satisfactory solution. In fact, after a lot of searching, I haven’t been able to find *anyone* who says they’ve successfully used one.

    Anyone with a success story or a link to tutorial on how to actually use them?

  15. Why can’t I have nice things?

    Because the cows, pigs and chickens needed them worse than you.

  16. Whatever happened to the research into Bacteriophages? The Russian surgeons were simply dipping a bucket into the river and testing for things-that-eat-bacteria, then producing a litre of them and spraying them into wounds.

    Is it just not profitable for Megapharmcos to invest in buckets?

  17. This is just the sort of thing that makes me glad to be asexual.

    As long as gonorrhea doesn’t find a way to infect me without having to touch people, I’m 100% safe.

  18. Honestly, people. Dangerous STDs are like colds and flus — the person you get it from seems fine until a few days (weeks, months, years, whatever) later, just as you do.

    The longer the incubation period, the worse the problem.

    And let’s be honest: the only reason we were able to eliminate smallpox was by accepting universal infant cowpox infection. Having a milder illness we voluntarily submitted our children to is not a common option.

  19. But if those “universal precautions” fail, like a condom breaking, then you’d statistically be better off having had broken that condom, say, with someone from the upper middle class in a developed country, and not, say, someone from the ghettos of a large city in sub-Saharan Africa…I’d appreciate these absurd positions not being brought to the table via unhelpful hypotheticals like the clean/dirty girl example you cite above.

    Well, that’s hysterically ironic, Mister UpperMiddleClassVersusSubSaharanGhettoExample. The point isn’t that some demographics don’t have a greater likelihood of being disease vectors. The point is that it’s irrelevant. Use precautions or only have sex with someone who you know enough to trust completely. Or accept that you’re playing Russian Roulette with your dick.

    1. Why ironic? They’re extreme examples, used to illustrate a point. Others could be adduced. The examples seem to have angered you, for reasons it would be unkind to speculate about.

      Indeed, these higher-risk demographics shouldn’t influence individual choices: an argument I never made and one I’ve repeatedly inveighed against. (“Be safe,” etc.) I’m ready to be wrong: kindly adduce examples that show lower HIV AIDS rates in African Americans than in whites, for example; or data that shows that sub-Saharan AIDS rates are drastically lower than those in the developed world. Anon’s response to me at #81 would be an example of such data.

      Mister UpperMiddleClassVersusSubSaharanGhettoExample

      And kindly refrain from name-calling, thanks! It rather renders our collective efforts to keep BoingBoing civil and informed, if not “hysterically ironic,” then certainly problematic. None of us is your enemy, individually or collectively, and we don’t deserve to be treated as such.

      1. You used an absurd example and then critiqued me for using a mainstream example.

        On the main point, educate yourself on the concept of universal precautions. The medical community ditched profiling as a definitive tool of infection control decades ago. You might choose to test someone from a country with high TB rates for TB, but you don’t assume that somebody from a country with low rates doesn’t have it. This has been standard practice since the 1980s.

        1. Sure! Wear that latex! Observe those universal precautions! I never said not to. The probability rates of patients or partners having an STD will still cleave, in the aggregate, to those demographic factors I cited above. That’s all: again, an unobjectionable, rather banal point.

          It’s been fun sparring with you, as always, but I’m rather tired of this, and we’re killing the thread.

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