No Clapping Matter: Antibiotic-Resistant Gonorrhea Is On the Way and We Are Not Prepared
When I was a peer sexuality educator at UMASS-Amherst back in the early 1990s we used to joke about the fact that the only gynecologist on staff at the health center was named Dr. Daniel Clap. At the time it seemed hilarious that the man charged with prescribing our pills and diagnosing our sexually transmitted diseases (STDs) seemed to be named after one of the most common STDs. None of us knew why gonorrhea was called the clap (more on that later). In truth, apart from making the joke about the gynecologist’s name, none of us thought much about this bacterial infection that had been reduced a nuisance by the advent of antibiotics long before we were born. Sure, we stressed how condoms can prevent gonorrhea and how important it was to get tested for it because it often has no symptoms but in the workshops we led we paid far more attention to the “4-H club” because these diseases—HPV, HIV, Hepatitis B, and Herpes—were ones you might have to live with for the rest of your life.
We were not alone in our complacency around gonorrhea. The disease is easily prevented by condoms, easily tested for in STD clinics, and easily cured. HIV got attention for being potentially life threatening. HPV got attention for being so widespread and leading to cervical cancer. Gonorrhea was annoying but not much of a menace. Deborah Arrindell, Vice President, Health Policy for the American Social Health Association (ASHA), explained it this way:
“We think of gonorrhea as a funny infection—the clap—that doesn’t kill anybody. But the consequences of untreated gonorrhea are quite serious; infertility, increased risk of HIV, and a big impact on our national wallet...nothing to clap about there.”
Today, many in the public health community will admit that we collectively took our eyes off the ball because Neisseria gonorrhoeaeis a very clever bug that has developed the ability to resist nearly all of the antibiotics that have been thrown in its path. It has steadily developed resistance to entire classes of antibiotics—as early as the 1940s it was resistant to sulfanilamides, by the 1980s penicillins and tetracyclines no longer worked, and in 2007 the CDC stopped recommending the use of fluoroquinolones (the class of drugs that includes Cipro, which we may all remember as the thing to stockpile in case of an anthrax attack). Today, the only class of antibiotics that remains effective are cephalosporins, but its susceptibility to these drugs is declining rapidly in the United States and other countries have already seen cephalosporin-resistant cases.
In February the Centers for Disease Control and Prevention (CDC) sounded the alarm about this growing threat and suggested that we need to change the way we screen for and treat gonorrhea in this country in order to respond to this wily germ. Last week, the World Health Organization (WHO) released a statement on this issue and, more importantly, a global action plan for stemming the spread of drug-resistant gonorrhea. As the resistant cases emerge, it is a good time to look at how we got here and what we can do to ensure that gonorrhea does not become a major public health threat.