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STDs

Exactly How Worried Should You Be About Super Gonorrhea?

Here’s what to do until someone develops kryptonite for the super clap.

Alexandra Ossola

Andrew Burton / Getty Images

You've probably seen some buzz about a particularly scary kind of gonorrhea. There have been reports of antibiotics-resistant strains of the STD in Japan, sprinkled around Europe (France, Spain, Slovenia, England), and, last fall, in Hawaii. But if you aren't screwing people in or from those places, just how concerned should you be about it? We spoke with a few experts to get the real picture.

In short, you should be pretty worried. At least, the Centers for Disease Control and Prevention (CDC) is—it lists Neisseria gonorrhoeae, the bacteria that causes the disease, as one of three "urgent hazards" of public health, alongside Clostridium difficile and carbapenem-resistant Enterobacteriaceae (CRE) bacteria.

"Most people thought the clap was a thing of the past. But it's not," says Scott Gray-Owen, an infectious disease researcher at the University of Toronto. In fact, not only is gonorrhea pretty common—more than 395,000 new cases were diagnosed in the United States in 2015—the rate of transmission is the highest it's been in decades, and it's only rising, he says. "I think for sure people should be worried."

Gonorrhea occurs most frequently in people between ages of 15 and 24, and you're more likely to get the disease if you have unprotected vaginal, oral, or anal sex with multiple partners, or a partner who's having sex with multiple partners. It seems that the body can eventually clear gonorrhea on its own, but people don't develop immunity and can be easily reinfected. (A journalist named James Boswell got it at least a dozen times in the late 1700s.)

That's bad news, because the STD can have some pretty nasty side effects if left untreated. In women, if the bacteria moves up into the uterus, it can cause pelvic inflammatory disease, a condition whose symptoms include long-term abdominal pain, scar tissue buildup in the fallopian tubes that can lead to ectopic pregnancies, and infertility. If a pregnant woman is infected, the bacteria can cause eye infections and subsequent vision problems for the baby after vaginal birth.

In men, gonorrhea can lead to infection of the testicles, prostate, or the epididymis (the tube that brings the sperm to the vas deferens, which sends it to the urethra), and could thereby lead to infertility. Gonorrhea can be life-threatening if it spreads to your blood or joints, but this is rare. Worst of all, lots of people (80 percent of women and 15 percent of men) don't have any symptoms, so they can pass it on without knowing they had it in the first place.

N. gonorrhoeae isn't totally resistant to antibiotics yet—even the resistant cases were eventually resolved with strong doses of antibiotics. For instance, the cases in Hawaii required doses of two powerful antibiotics, ceftriaxone and azithromycin, each of which used to treat gonorrhea on their own, but are now served together as the standard treatment for the disease.

Like all bacteria, N. gonorrhoeae will eventually develop resistance to antibiotics. Researchers think it may be doing so more quickly than other bacteria, but there aren't studies to support that. "The fact that the agents we use to treat gonorrhea are beginning to lose reliability isn't a surprise," says Edward W. Hook III, a professor of medicine, epidemiology, and microbiology at the University of Alabama at Birmingham School of Medicine. "The problem we have is that the antibiotic pipeline dried up about 20 years ago."

As pharmaceutical companies have pivoted toward drugs that will make them more money (read: treatments for chronic illnesses), doctors have had to start giving longer, larger doses of the same-old antibiotics to knock out cases of gonorrhea.

Still, lab tests on resistant strains have shown that a totally resistant superbug might not be far off. For researchers and public health officials, that's a scary prospect. "So far there's no strain that is resistant to every [antibiotic], but this will come," Gray-Owen says. "We don't know when, but it will come. That would effectively be an untreatable infection."

The CDC is working diligently to stay ahead of that. The agency recommends the current two-drug cocktail and tracks all cases of gonorrhea; if a patient doesn't immediately respond to the standard regimen, CDC researchers test samples of the bacteria to understand just how resistant that strain is. The agency's work has allowed physicians to stay one step ahead of the disease, which is much easier—and less risky—than treating cases once they arise, Hook says.

Other researchers are looking into new treatments. There's a big push for new antibiotics, of course, which could work to treat gonorrhea and a slew of other disease-causing bacteria, such as C. difficile and CRE on the CDC's hit list, but some are targeting their efforts to gonorrhea in particular.

One Canadian researcher has created star-shaped proteins that tear through the cell wall of the bacteria to kill them rather than "poison" the bad cells. It seems unlikely that the bacteria would ever be able to develop resistance to the destructive technique, though it might not be ready for public use for another five years. Other researchers, including Gray-Owen, are working toward a vaccine for gonorrhea, preying on the qualities of N. gonorrhoeae that make it so uniquely suited to infect humans. "There are candidates, but we're not close…we're years away," he says, though several international health agencies are behind the project, which might speed up the timeline.

Until that day comes, though, we can all do our part to stop gonorrhea from spreading. You know what that means: Wear condoms. Get tested. And communicate with your partner(s) if you test positive.

Gray-Owen understands that choosing safe sex can be difficult when you're in the moment. But losing a few seconds while you fumble to find a condom is way better than being the unlucky person who gets the world's first case of completely resistant gonorrhea.

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