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Gonorrhea may soon be untreatable, Britain’s chief medical officer warns

A medical illustration of Neisseria gonorrhoeae. (CDC)

Dame Sally Davies, Britain's chief medical officer, has reportedly written to doctors and pharmacies in Britain sounding the alarm on antibiotic resistant gonorrhea.

The sexually transmitted infection is increasingly caused by strains of Neisseria gonorrhoeae that resist antibiotic treatment. “Gonorrhoea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance,” Davies wrote. The Guardian reports that a recent outbreak of a superbug strain of the disease — one that doesn't respond to the antibiotic azithromycin — has put Britain on high alert.

Davies urged doctors to use proper treatment protocols. A recent study found that many doctors in Britain still prescribe ciprofloxacin, which hasn't been recommended for a decade now.

Things aren't much better in the United States: 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.

In the United States, there were just over 350,000 cases in 2014; Britain had about 35,000.

Doctors in the United States are now told to use a combination of the antibiotics ceftriaxone and azithromycin. For a while, this strategy seemed to be working: A recent study found that resistance to ceftriaxone, a marvelously effective drug at the time of its release, had dropped from 1.4 percent of gonorrhea cases in 2011 to just .4 percent in 2013. But in 2014, the resistance doubled.

Why does this happen? When researchers look for new antibiotics, they obviously look for ones that are incredibly effective against pathogenic bacteria. But as soon as these antibiotics are released for use by the public, they start to lose their effectiveness. Bacteria are fast-evolving creatures, and individual bacterium are skilled at sharing genes that allow them to survive particular antibiotics. Bacteria can even copy resistance genes from microbes of different strains and species through a process called horizontal gene transfer.

Superbug known as ‘phantom menace’ on the rise in U.S.

Historically, humans haven't done much to slow this process. Whenever you take antibiotics you don't need, you're introducing bacteria in your body and your environment to the drug, giving those microbes an opportunity to learn resistance to it. Whenever you don't finish an entire prescription of antibiotics, you're leaving behind bacteria that showed some resistance to the first few days of treatment, and allowing them to reproduce. When farmers treat healthy livestock with antibiotics in order to promote growth, they're breeding resistance in our meat and in our soil. Now that we know how dangerous this process is, it may be too late to stop it.

It's possible that scientists will develop new classes of antibiotics that are less likely to fall into this cycle. But for the most part, this is just how bacteria work — so it's our use of antibiotics that really has to evolve.

Antibiotic resistant gonorrhea has an especially creepy ring to it. Sexually transmitted infections are highly stigmatized, so the idea of one you can't get rid of with standard treatment is understandably scary. But as scary as it is, gonorrhea is hardly the biggest of our worries when it comes to antibiotic resistance. This problem isn't going to go away.

Correction: An earlier version of this post stated that U.S. doctors use ciprofloxacin in combination with another antibiotic, when in fact they use ceftriaxone in combination with another antibiotic. This has been corrected. A second reference to the same drug was also corrected. 

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