

If you've been reading along, you might remember that in the past year, there has been increasing alarm in the public health community about rising rates of drug-resistant gonorrhea, an almost-beaten sexually transmitted disease that has steadily become resistant to just about all the drugs that can be used against it in the outpatient clinics on which STD control relies. (If you haven't been reading along, then first, Welcome, and second, here are one two three four posts about the problem.)

Highly resistant gonorrhea – which is to say, gonorrhea that has already become resistant to sulfa drugs, penicillin, tetracycline, and fluoroquinolones such as Cipro, and that is gaining resistance to cephalosporins — first emerged in Japan and over the past decade was carried to the western United States, and then crossed the country. But a recent issue of EuroSurveillance, the journal of the European Centre for Disease Prevention and Control, warns that cases are now increasing in Europe, and exhibiting resistance against the last drug that both worked and was uncomplicated to use.

To make sense of this news, it helps to know that effective STD control depends on drugs that are inexpensive, effect a cure in one or a small number of doses, and are easy to administer or take. The last-ditch defense against resistance in gonorrhea has been two drugs in the class known as "third-generation cephalosporins": cefixime, which comes in pill form, and ceftriaxone, which is injectable. *(Update: This post originally reversed the drug names; I have corrected.) *Once those become no longer effective, public health will be forced to use newer and thus more expensive drugs, or ones that can only be given by IV, and thus require additional healthcare attention and time. The fragile affordability of STD control – already undermined by cuts to state and national budgets – is then expected to break down, increasing the chances that infected people will not be identified or tracked down, and that resistant disease will spread. Decreased susceptibility, and then resistance, to cefriaxone is bad; to cefixime is worse.

And as shown in the map to the right (apologies for the poor image quality, here's the original), increasing numbers of gonorrhea infections in Europe actually are showing decreased susceptibility to cefixime – not yet totally resistant, but definitely on the way. In the countries in bright red, fewer than 5 percent of cases are less-susceptible; in dark red, more than 5 percent. The pale blue dots indicate cases where there have been complete treatment failures: The drug no longer worked. The countries where treatment failures have occurred include Spain, France, Norway, Sweden, Austria, Slovenia and the UK.

The EuroSurveillance article underlines why this is bad news:

Effective control of gonorrhoea relies entirely on successful antimicrobial treatment. Untreated infections can lead to severe secondary sequelae, including pelvic inflammatory disease, first trimester abortions, ectopic pregnancy and infertility, and may contribute to facilitating HIV transmission.

Just as icing on the cake, the same journal reports that diagnoses of gonorrhea, and also syphilis, are spiking in England. Which puts a slightly different spin on reports that the dating app Grindr crashed shortly after Olympic athletes arrived in London (the company says the server downtime was coincidental).Fortunately, according to Time, the furnishings in the Olympic Village include a record number – 150,000 – of complimentary condoms.

Cite: Van de Laar M, Spiteri G. Increasing trends of gonorrhoea and syphilis and the threat of drug-resistant gonorrhoea in Europe. Euro Surveill. 2012;17(29):pii=20225

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