It's no news that gonorrhea is a big problem. At face value, it's not the scariest disease in the world: It's sexually transmitted but can largely be avoided by using condoms. In its worst cases it can cause infertility or even death, but most patients will experience nothing more than itchy discharge and painful urination. And hey, at least it's treatable!
Except that it's not really treatable in all cases. Neisseria gonorrhoeae, the bacterium that causes the infection, is getting better and better at surviving the antibiotics we throw at it. Every time the bacteria in one person mutate enough to survive a course of treatment, it makes the overall disease that much more difficult to treat. More and more of the gonorrhea out there is caused by these resilient microbes.
In 2013, the Centers for Disease Control and Prevention gave it the centers' highest ranking for antibiotic resistance, classifying gonorrhea as an "urgent threat". At that time, the CDC reported that around a third of cases were resistant to at least one antibiotic.
To get around that problem, the CDC updated its treatment guidelines to recommend a two-pronged treatment plan: A dose of ceftriaxone (which used to work on its own -- and at lower doses than currently recommended) along with a second antibiotic.
As part of the CDC's Gonococcal Isolate Surveillance Project, which studies samples taken from the urinal opening of men with gonorrhea, researchers have been keeping an eye on responses to ceftriaxone. They looked at 51,144 samples from clinics in 34 different cities, from 2006 through 2014. At first, the researchers could see the decline of ceftriaxone's effectiveness as its popularity grew: The percentage of patients treated with it skyrocketed from 8.7 percent to 96.6 percent over the eight years of the study, and resistance rose from .1 percent in 2006 to 1.4 percent in 2011.
In 2013, it seemed like things were getting better -- perhaps because of the new recommendation, which paired ceftriaxone with a buddy to give the treatment a one-two punch. Resistance went back down to around 0.4 percent
"Although this improvement in susceptibility appears temporally correlated with treatment guideline changes, we cannot establish a causal relationship," the authors write. "The 2014 data, however, suggest that improvements in susceptibility may be short-lived."
From 2013 to 2014, the resistance doubled: The percentage of isolates with reduced susceptibility to the antibiotic rose back up to 0.8 percent.
It's not exactly apocalyptic, but it confirms what doctors already knew: This problem isn't going to go away. Not with gonorrhea, and not with any bacterial infection. We can't expect antibiotics to work forever, and at the very least we're going to have to keep finding new, better ones with which to treat our ever-mutating microbial foes.
In the meantime, what can you do? Get tested frequently for STIs, and keep an eye out for any symptoms. Practice safe sex (and I mean all sex -- no one wants antibiotic resistant throat gonorrhea, which is a thing you can get) and see a doctor right away if something seems off. And if you end up needing to take antibiotics for gonorrhea, take them as directed -- and make darn well sure you finish off the prescription. Neisseria gonorrhoeae is doing a fine job of breeding a bacterial super army all on its own. It doesn't need any help from you.