fbpx 'Superbug' STDs, Explained
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'Superbug' STDs, Explained

Learn about the growing threat of antibiotic-resistant bacteria in the bedroom.
Written by

Tim Lalonde

You might have read a story about "superbug" sexually transmitted diseases (STDs) in the past few years, or seen the Twitter buzz around the news that the COVID-19 pandemic was fueling the spread of a new "super gonorrhea."

But what makes an STD "super" in the first place and what kind of problem will these diseases pose in the future?

The answer to the second question seems to be "a big one," according to Edward Hook III, M.D., emeritus professor of infectious diseases at the University of Alabama Birmingham and director of the STD control program for Jefferson County Health Department.

Hook has researched sexually transmitted infections (STIs) for more than 40 years and consults for both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). He believes antibiotic resistance in bacteria—including but not limited to those that cause STIs/STDs—represents a major looming threat to public health.

Three of the most common bacterial STDs—chlamydia, syphilis and gonorrhea—have all shown evidence of some degree of antibiotic resistance, according to the WHO, leading to changes in recommended treatments.

Right now, antibiotic-resistant gonorrhea, also known as super gonorrhea or gonorrhea superbug, presents the biggest problem by far, Hook said. In a 2019 report, the CDC named Neisseria gonorrhoeae, the bacterium behind gonorrhea, among the bacteria that pose an "urgent threat."

Gonorrhea is the second most common STD, after chlamydia, in the United States. Ever since doctors began treating gonorrhea with antibiotics in the early to mid-20th century, the disease has steadily grown more and more resistant to treatment, Hook said. This process continues to this day.

Medical science has been able to keep pace with the disease by modifying treatment, either through developing different antibiotics or using larger doses of the same antibiotics. But scientists are becoming increasingly concerned that effective treatment options will dwindle and a new, untreatable version of the STD looms in humanity's future.

"So far, we've done pretty well," Hook explained. "The problem is that right now, there are no new antibiotics. And so we're faced with the threat of—if this process continues—having more and more problems with treatment failures."

What is antibiotic resistance?

Antibiotics have remained a cornerstone of modern medicine since the discovery of penicillin in 1928. For many diseases—including gonorrhea, syphilis and chlamydia—they're the only safe and reliable form of treatment available.

But there's a problem built into how antibiotics work. Antibiotics cure infections by disrupting certain processes in bacteria, either preventing them from spreading, slowing their spread or killing them outright.

Eventually, however, certain bacteria develop mutations, which allow for survival. Those bacteria then split and multiply, spreading between hosts until there's a new generation of treatment-resistant bacteria traveling around the world.

Hook said antibiotic resistance has been building for decades, ever since doctors began treating the disease with penicillin.

"Every five to 10 years has required a change in the recommended treatment," Hook said.

Treatments for gonorrhea over the past few decades provide a good example. From the 1940s to the early '70s, penicillin was the go-to treatment. Over that time period, the recommended dose increased more than a hundredfold before it was finally succeeded by newer antibiotics.

Modern antibiotic development lags behind

Modern medicine has been able to stay ahead of gonorrhea and other bacteria by developing new antibiotics, but that progress has slogged in recent decades.

James Collins, Termeer professor of MIT's department of biological engineering, said the heyday of new antibiotic drugs is behind us. Today, the drug development process is at high risk of lagging behind the speed of antibiotic resistance.

"What's underappreciated is that the golden age of antibody discovery was in the '40s, '50s and '60s," Collins explained. "Discovery has not kept pace with the emergence of resistance, and not as many resources are going into antibiotic drug discovery."

Drug companies have also shifted their attention away from antibiotic development in the past few decades, Collins noted, focusing on more lucrative endeavors: Developing an antibiotic that requires only a one-time dose brings in less money than, say, a blood pressure medication that patients take for months.

"Over the past decade, many, many biotech and pharma companies have gotten out of the antibiotic business," Collins said. "So we're facing a new crisis of increasing resistance with a diminishing pipeline."

When treatment fails

Super gonorrhea is fairly rare in the United States, Hook said. But it's already presenting enough of a problem in the doctor's office at its current levels.

"Here in the United States, only a small proportion—that is, less than 5 or 10 percent—of all gonorrhea is highly resistant to the antibiotics that we use," he said. "But on the other hand, that means there's a 1 in 10 or 1 in 20 chance that the treatment you have will fail. That's not really acceptable."

Moreover, the treatments are becoming more difficult to administer, with injections replacing single-dose oral medications.

"Up until the last decade or so, we've had the luxury of being able to reliably treat most sexually transmitted infections—including gonorrhea—with antibiotics that can be taken by mouth and given a single dose," Hook added.

The main threat comes from a case of antibiotic-resistant gonorrhea spreading to more and more people, Hook said.

Gonorrhea typically isn't fatal but can still lead to serious complications, including blindness, infertility and chronic pain. It can also increase the risk of HIV transmission by about three to five times, Hook said, and in rare cases, can spread to the blood and joints and cause a life-threatening condition.

What can be done about superbugs?

Antibiotic resistance isn't just a problem with STDs. Some of the bacteria behind pneumonia, urinary tract infections and skin infections also ranked high on the CDC's 2019 watchlist.

Even broader, superbug bacteria pose an "existential threat," Collins said. He pointed to a 2019 report commissioned by the United Kingdom government stating an estimated 10 million people will die each year from antibiotic-resistant infections by 2050—outpacing cancer as a leading cause of death.

The CDC is closely monitoring the problem of antibiotic resistance, Hook said. In 2020, the public health body altered its recommendations for gonorrhea treatment, switching from two different antibiotics to just one. It has also issued guidelines for treatment that discourage excessive antibiotic use.

Collins' lab at MIT in Cambridge, Massachusetts, has been working to develop new antibiotics through research assisted by artificial intelligence (AI). By testing a massive library of compounds against some of the most high-risk bacteria—including gonorrhea—the team is hoping to discover and design new antibiotics that don't look like their predecessors.

The results thus far have been promising, Collins said, but he still feels that not enough attention is being paid to the problem. Solving the problem of antibiotic resistance will require a much broader global effort across many different sectors.

"We need to rally the world," he said. "We need to rally young talent, we need to rally nation-states—frankly, we need to rally biotech pharma—to engage in this effort."