Sex and the new gonorrhea super bug
Antibiotic use, and misuse, has created a monster: gonorrhoea is developing antibiotic resistance.
There’s perhaps no worse dinner-table conversation than sexually transmitted disease, all those rashes and lumps and discharges mingling with the steak and mashed potato. It’s not what you would call a watercooler topic either, or something for idle chitchat outside the school gate or at the local shops. But if STDs are so abhorrent, then maybe they need to be mentioned now and again to shock people into action. Not just safe sex but also responsible health and hygiene practices more broadly. Now is one such occasion because one STD in particular is part of a huge problem.
Gonorrhoea is a serious infection of the genital tract in men and women. It has imaginably harsh, localised symptoms but also can cause throat infections, joint pain and infection, and conjunctivitis of the eyes. It can leave young women infertile. For some time now treatment has been relatively simple (if given soon after infection and diagnosis) in the form of antibiotics. But antibiotic use, and misuse, has created a monster: gonorrhoea is developing antibiotic resistance, making it one of the much-feared superbugs.
Superbugs, in case you haven’t heard, are challenging the health system like nothing else in the modern era. They’re making simple health problems complicated, making straightforward hospital procedures dangerous and raising the stakes in infectious disease control. And all because antibiotics, which have saved millions of lives, are overused and misused.
Released this week, the first report from Australia’s National Alert System for Critical Antimicrobial Resistances (CARs for short — nasties that are able to fend off last-line drugs) received 1064 notifications from 73 laboratories.
Before December last year the most commonly reported CARs were carbapenemase-producing Enterobacteriaceae, also known as CPE. One type of CPE, called the IMP type, is endemic on the eastern seaboard, especially in hospitals. Since December, however, the most frequently reported type of CAR was a strain of the bacterium that causes gonorrhoea that is no longer susceptible to the antibiotic azithromycin.
This azithromycin-resistant Neisseria gonorrhoeae accounted for 62 per cent of all CARs reported to the CARAlert system in March and 67 per cent in February. There was an increase in reports of this CAR originating in South Australia last year, and numbers increased threefold in NSW and Western Australia throughout last year.
Why is that a worry? Well, put simply, anyone who has sex with an unprotected partner, especially a new partner, is potentially at risk of gonorrhoea and, if infected, will find it more difficult to treat. Apart from the obvious impact on the patient there is an added burden on health services that stretches the system and the budget. And this is just one kind of superbug.
John Turnidge, an expert on superbugs, says clinicians are looking at older, more potent drugs, including some that have been deregistered in Australia, to treat this resistant strain of gonorrhoea.
“It’s one of those conditions where we have a complete understanding of how it spreads in our community so we know what the strategies are to get it under control,” he says. “But resistance in gonorrhoea is on the rise and it’s not good for you and it’s not good for the people you have sex with because we don’t eradicate the germ.”
This isn’t just a concern for the southern states or even Australia. This is an international problem, and two weeks ago the World Health Organisation called for a multinational response against 12 antibiotic-resistant families of bacteria, including gonorrhoea.
Turnidge is special adviser to the Australian Commission on Safety and Quality in Health Care for the CARAlert surveillance system. He says the first report can be used as a baseline, but the figures are still higher than they should be and he holds out hope for a reduction in future.
An infectious disease physician and microbiologist, Turnidge headed the first major examination of the issue in 1999 and is still saying the same thing he said then: Australians use too many antibiotics. In the early 2000s, antibiotic usage started to fall, as hoped, but it increased again and has stayed high for a decade. Turnidge points to The Netherlands as an example of how a country could use half as many antibiotics per capita as Australia with no adverse outcomes.
Just over a week ago, The Medical Journal of Australia published a study led by Chris Del Mar from Bond University showing GPs are prescribing antibiotics for acute respiratory infections at rates four to nine times higher than recommended by national guidelines.
Even when there are guidelines, there is overprescribing. Turnidge believes national efforts to reduce the prescribing rate, and educate consumers on the appropriate use of antibiotics, need to be stepped up to have an impact.
“We know that once we introduce and spend time and energy promoting stewardship programs we can turn that around,” he says.
The commission recently noted that use of antibiotics in hospitals fell by 7.6 per cent between 2011 and 2015.
“But I think more needs to be done, we’ve been doing much the same for 15 years with NPS MedicineWise (which promotes evidence-based practices),” Turnidge says. “Turning around 30 million scripts to 24 million Australians is going to be like turning around the Titanic — we’re going to need a lot of ropes and pulleys.”
Encouraging doctors and hospitals to prescribe fewer antibiotics, or prescribe only when clinically indicated, is one side of the response. Consumers, too, need to realise antibiotics are not a cure-all and, when they are prescribed, need to be taken responsibly. Most people know what it is like to have a cold, feel miserable and wonder if antibiotics might help. But imagine how it would feel to catch, say, a drug-resistant strain of gonorrhoea — or even something airborne such as multi-drug resistant tuberculosis, which is on Australia’s doorstep to the north — and know the drugs that could help already have been rendered useless.
HOW TO PROTECT YOURSELF
Antibiotics are medicines used to treat a wide variety of infections or diseases caused by bacteria, such as respiratory tract infections (such as pneumonia and whooping cough), urinary tract infections, skin infections and infected wounds. They work by blocking vital processes in bacteria, killing the bacteria or stopping them from multiplying. This helps the body’s natural immune system to fight the bacterial infection. Different antibiotics work against different types of bacteria.
Doctors choose an antibiotic according to the bacteria that usually cause a particular infection. Sometimes your doctor will do a test to identify the exact type of bacteria causing your infection and its sensitivity to particular antibiotics.
Good-quality, reliable clinical studies have shown that antibiotics do not improve the symptoms of a cold or the flu. This is because antibiotics work only on infections caused by bacteria — common colds and the flu are infections caused by viruses.
If you are generally healthy your immune system will take care of most respiratory tract infections — viral as well as some bacterial infections — by itself. However, antibiotics are more likely to be needed for people who are older, in generally poorer health, or have a weakened immune system — or in special circumstances.
Using antibiotics when you don’t need them can contribute to the problem of antibiotic resistance. This might mean that if you have a serious infection such as pneumonia in the future, antibiotics may not work as well.
If you are prescribed antibiotics, it is important that you follow your doctor’s advice on when, how and for how long to take them. The consumer medicine information for your medication is also helpful.
Antibiotic resistance happens when bacteria change to protect themselves from an antibiotic. Bacteria become resistant when their genes mutate after being in contact with an antibiotic. These changes allow the bacteria to survive or “resist” the antibiotic, so that the antibiotic no longer works to kill the bacteria or stop them from multiplying.
Unfortunately, bacteria can also develop antibiotic resistance through contact with other bacteria.
Resistant bacteria can pass their genes to other bacteria, forming a new antibiotic-resistant strain of the bacteria, or superbugs.
The more antibiotics are used, the more chances bacteria have to become resistant to them.
If you have an antibiotic-resistant bacterial infection you will have the infection for longer, may be more likely to have complications, and could remain infectious for longer and pass your infection to other people, which increases the problem.
You could be passing on antibiotic-resistant bacteria to other people if you take antibiotics for cold and flu viruses, if you don’t take antibiotics as prescribed, or if you neglect good hygiene.
Source: NPS MedicineWise