Antibiotic resistant gonorrhea and the future of oral sex

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.