The end of cheap STD control?

More than 700,000 people in the United States probably get gonorrhea each year. I say "probably" because the Centers for Disease Control doesn't know for sure. It's an estimate, because a lot of those cases go untested, unreported, and untreated.

The good news is that, since the 1940s, getting people to get themselves tested has been the hard part. Once you know the gonorrhea is there, antibiotics have made it both easy and cheap to treat. The (more) bad news: That's changing.

At her Superbug blog, Maryn McKenna talks about the threat of antibiotic-resistant gonorrhea—it's not just an issue of health, it's also an issue of how much health costs. So far, there's not been gonorrhea reported that's immune to all the drugs we can throw at it. Just the inexpensive drugs. Anticipating big problems when treating gonorrhea becomes a pricy proposition, the World Health Organization has put together a plan for improving treatment today.

The plan specifically calls out an aspect of the growing resistance problem that we highlighted at SciAm: Community control now depends on rapid molecular tests that identify the gonorrhea organism (Neisseria gonorrhaea) but cannot distinguish between drug-susceptible and antibiotic-resistant organisms. Hence, patients who were treated, and then went back to their doctors with the same symptoms, were assumed to have been cured and then reinfected. Physicians have not had the tools to identify ongoing infections that never responded to treatment — and patients who had those resistant, not-responding infections then went on to unknowingly infect others.

In order to address that problem, the plan calls specifically for improvements in lab capacity, diagnosis and surveillance, as well as asking for things that apply to the greater problem of antibiotic resistance: improved awareness, bigger efforts at prescribing antibiotics appropriately and better drugs. One thing that it particularly calls for — as the CDC did in the New England Journal last February — is for physicians to start applying a “test of cure,” actually checking microbiologically to see whether a patient who was prescribed an antibiotic for gonorrhea is clear of infection, or harboring a resistant strain.

Of course, that's expensive, too. The cheapest option is still to not get gonorrhea at all. Get tested. Make sure your partners are tested. And use protection. In the future, we're not going to be able to afford treating some STDs as "no big deal".

Read more about the WHO plan and antibiotic-resistant gonorrhea at the Superbug blog


  1. This is information that I like knowing about, but at the same time I’m not worried about.  I’m more worried about MRSA or other more common bacteria that I encounter on a daily basis.  

  2. When it matters, is there a difference between the STDs that are “a big deal” and those that aren’t. You either wear protection or risk dying of AIDS. Add a few other illnesses into the mix and it still doesn’t really come close to dying.

    1.  Except that the chances of transmission vary dramatically, with HIV being small enough for many people to take chances with no consequence of contracting HIV:

      I actually read recently about how the transmission rate for HIV is massively higher during the first 6 weeks of infection due to a spike in viral load. Promiscuity is still problematic, but a single mistake _usually_ isn’t.

    2. Except much money and time has been spent turning the perception of AIDS into it is something manageable.  Once upon a time they had posters advertising their latest super drug showing someone rock climbing, what they never hinted at was that you’d spend hours on the toilet feeling like total crap.

      AIDS is no longer the death sentence it once was, but managing it is not a bed of roses.  I think we need to be concerned about gonorrhea that might become “uncureable” and what else might follow suit, and the fact that it is still spreading when everyone is supposed to know better is a terrifying thought as well.

  3. Follow up? Test of cure? You don’t build a million dollar practice that way! You get em in you get em out, who cares if it’s revolving door that’s not actually solving your patients medical problems. This is America, you are free to make as much money as you can and crazy if you do anything other than that.

  4. Nasty little buggers. They actively edit their own genomes, y’know, you think you’ve got a handle on ’em and they just swap in a new cassette.

  5. Two and a half decades ago (gasp) I had the good fortune to do summer employ at an overseas US Army base hospital, in their microbiology lab.  There was this big Andromeda Strain like tank filled with dry ice into which we packed samples of all positive gonorrhea cultures from infected soldiers and their paramours when “captured”.   These tanks were picked up monthly by very efficient officers from Virginia, and returned to such.  I found out they were doing surveillance for antibiotic resistant gonorrhea back then.

    Fast forward to five years later, I had the fantastic opportunity to work at an amazing NFP women’s clinic in California that rcvd state monies (Gray Davis era) for access to sliding scale contraception and FREE STD tests.  At the time all tests were covered excepting chlamydia (then white college girls started getting it and often had sequelae fertility issues, and SURPRISE!  they started to pay for it).  ANyway, surveillance happened if and when women who had previously detected and treated STI’s returned for affordable contraception, a true captured cohort for retesting.

    Why all this info?  When Mitt Romney and SCALITOS revoke Title X funding and access to the only affordable health care most women have vanish ala’ Texas, they are killing the canary before it gets in to the coal mine.  It is sad to say but we may be “sluts” but we are your “sluts’ and as such you need us and our sluttish enablers (PP and other NFP women’s health programs) to let you men know when you are at risk of getting sick and maybe even sicker.  Sigh…..

    Cool article Maggie…..

  6. Oh yeah, sorry to be the haranguing curmudgeon that I am, but I have always preferred to use the term STIs (Sexually Transmitted Infections) to STDiseases, I felt it minimized stigma and as such decreased the shame associated with testing and increased the chance of people informing their sexual partners of possible exposure.

    A term that I swear I coined and put into heavy rotation at conferences and clinics, but I recognize that is being all to Al Gore “I made the internets”, so maybe it was just a dream I had : )

  7. I work at a place that sees & treats teens for STIs. A lot of times the teens will not be treated under their health insurance, since their parents might then get access to the fact that they had an STI in the first place. By the time we know they have gonorrhea (or chlamydia, or anything) they are out of the office and we can’t sneakily give them meds or injectables. Our saving grace is that most teens can scrape up enough cash for a generic antibiotic and buy it over the counter. We always ask them to f/u for a test to make sure it’s gone, but you can guess how often that happens.

    If gonorrhea that is resistant to cheap antibiotics becomes widespread, we’re going to be up a creek. Teens can be so paranoid about their parents knowing they are sexually active in the first place that it throws a huge wrench into treatment. And then you end up with untreated gonorrhea and all the havoc it can cause.

    Also, anyone low-income without health insurance will be up a creek if the necessary antibiotics are expensive. Our state budget has been cut so much that some counties aren’t even able to take of all the latent TB cases anymore, it’s not like we can set them to figuring out new solutions. I’m depressed, I’m going to go eat some chocolate.

    I hope syphilis stays nice and susceptible to penicillin.

    1. So far that’s actually the case — syphilis is not becoming resistant. (IANAA microbiologist, so can’t explain why.) But the point you make is really important, that people don’t go to their regular doctor for STD issues, but prefer to go to the anonymous clinics. That’s true for adults as well as teens — and apparently it’s true even if care is paid for, for instance under an individual mandate. So it’s important to keep funding the public clinics no matter what else we do with healthcare.

      (Thanks for the Boing, Maggie!)

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