The First Outbreak of Drug-Resistant Gonorrhea Hits the U.S.

Doctors and health workers have warned for years that overuse of antibiotics would lead to this happening:  a new strain of antibiotic-resistant gonorrhea has been reported in Hawaii. How’s that for a souvenir? Apparently, by being situated between Asia and the U.S. mainland, the tropical paradise is also a breeding ground for sexually transmitted infections (because, according to the World Health Association, the Asia and Pacific region have "by far the greatest number of curable bacterial STIs of all the global regions").

Gonorrhea is such a ubiquitous part of American adolescence, it's almost considered a rite of passage among American youth and it permeates pop culture and teen movies. Its nickname, “The Clap,” sounds like something you do in a sports arena rather than a sexual infection that can lead to serious complications including death. 

There are a number of theories about the origin of the term, ranging from the French word for brothels, clapier (in France, the disease was known as clapier bubo); or referencing a (clearly discredited) treatment involving clapping on both sides of the penis or “banging the butt of their rifles on the penis laying on a table” to break up the pus or discharge. Fun stuff. The folks at Merriam Webster trace the origin “from Old English clæppan to throb; akin to Old High German klaphōn to beat,” which reflects both the throbbing nature of the illness and the above mentioned folk remedy.

The disease has been around for at least 800 years—and people have been trying to stop its spread ever since. According to News Medical, the earliest medical treatments involved shooting metals (mercury, silver, gold etc.) into the urethra. The first vaccine was introduced in 1909, but it wasn’t until the 1940s that antibiotics, most notably penicillin, became widely accepted as the go to treatment for gonorrhea. By 1980 the first antibiotic resistant strains were identified, and the CDC says the disease has now “developed resistance to nearly every class of antibiotics used to treat it.” Now the agency recommends doctors hit gonorrhea with a two-pronged approach: a single shot of ceftriaxone and an oral dose of azithromycin.

Since 2010, the rates of gonorrhea among gay men have been rising, reflecting a drop in condom use. Between 2005 and 2014, the number of HIV-negative gay and bisexual men who reported having sex without a condom rose from 29 percent to 41 percent. Neither the rise in condomless sex nor gonorrhea rates are related to use of PrEP — usage of which remained low until the last few years.

Just as the rates are increasing, new reports confirm what the CDC has long feared: treatment resistant gonorrehea threatens to dramatically change the STI landscape.

“Our last line of defense against gonorrhea is weakening,” Jonathan Mermin, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, told the press, “If resistance continues to increase and spread, current treatment will ultimately fail and 800,000 Americans a year will be at risk for untreatable gonorrhea.”

Read More: The Counties With the Highest Gonorrhea Rates in the U.S.  

Gonorrhea may be so common as to seem like a simple rite of passage, but untreated gonorrhea can spread into blood or joints, becoming life-threatening, especially for those with compromised immune systems. (Untreated gonorrhea can also increase your chances of getting or transmitting HIV.) 

While PrEP and TasP may open up a new world where we can have condomless sex and still remain healthy, those HIV-prevention methods do not prevent other STIs like gonorrhea.  In light of this, Dr. Robert D. Kirkcaldy of the CDC, recommends “Condom use, abstinence, and reducing the number of one’s sexual partners, particularly among users of the HIV prevention strategy PrEP who choose to bareback.”

Researchers are also trying to develop new treatment options like ETX0914,  which works differently from any antibiotic currently on the market, and is showing promise in clinical trials.

And, Mermin points out that so far, the current system has continued to work. “In Hawaii …front-line providers diagnosed and treated infections, public health officials quickly detected resistance, and we were able to use cutting-edge lab technologies to track its spread and treat people who were linked to the cluster. A strong STD prevention and control infrastructure is critical to ensure we’re ready to confront drug resistance not just in Hawaii, but nationwide.”