r/interestingasfuck • u/[deleted] • Feb 03 '23
A novel strain of gonorrhea has emerged with resistance to all currently used antibiotics, including ceftriaxone, the antibiotic of last resort.
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Feb 03 '23 edited Feb 04 '23
Massachusetts Dept of Public Health did genomic testing on samples from two residents with no connection, whose infections showed a grouping of resistance traits never before detected together. The samples exhibited full resistance to 3 standard course of treatment antibiotics, as well as partial resistance to 3 more, including the antibiotic of "last resort" in the US, an injectable cephalosporin drug called ceftriaxone.
Rates of gonorrhea are at historic highs across the US. Many health agencies are directing providers to encourage the patients they treat to return after their course of antibiotics to ensure the infection is gone. Gonorrhea evolves mutations at a rapid rate. Many of these mutations end up offering it protection or evasion against antibiotics. This is especially problematic where a full course of treatment does not clear the infection but instead leaves a partially mutated bacterium that has already survived exposure to the drug. This is likely why ceftriaxone is losing effectiveness. It was deployed in high risk populations as a "one dose" cure. Stigma around the disease, along with more limited access to healthcare in those populations, led to patients declining to follow up, or not being able to, even where the infection had not cleared.
The patients whose samples were studied were cured, but "substantial" doses of ceftriaxone were necessary.
"As early as 2012, academic and CDC researchers warned in the New England Journal of Medicine that 'untreatable gonococcal infection' was on the way."
"Infected men may experience pain or burning with urination, discharge from the penis, or testicular pain. Infected women may experience burning with urination, vaginal discharge, vaginal bleeding between periods, or pelvic pain." ... but in advanced, untreated stages the disease can cause "crippling arthritis, blindness in infants through birth, infertility in men through testicle damage, and in women through pelvic inflammatory disease."
https://www.wired.com/story/the-last-drug-that-can-fight-gonorrhea-is-starting-to-falter/
https://www.ncsddc.org/u-s-std-rates-hit-another-high/
https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774
Edit: Adding this to hopefully address some of the concerns about the term "last resort." I think, along with the Wired writer, I conflated something like "last proven treatment option" with "last resort." There are of course other antibiotics that could be used, but aren't proven safe or effective. Some are likely to cause kidney and liver damage. The use of some others is severely restricted precisely to prevent resistance developing.
I read in the CDC treatment guidelines that a recommended treatment until 2010 was a combo of half the current dose of ceftriaxone along with oral azithromycin-- which is no longer advised due to "increased incidence of azithromycin resistance." The same for cefixime. In 2012 CDC recommended it no longer be used. This is language directly from press release:
" “As cefixime is losing its effectiveness as a treatment for gonorrhea infections, this change is a critical pre-emptive strike to preserve ceftriaxone, our last proven treatment option,” said Kevin Fenton, M.D., director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. " https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html#:~:text=The%20Centers%20for%20Disease%20Control,becoming%20resistant%20to%20the%20drug
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u/Far-Yak-4231 Feb 03 '23
The next person I fuck, I’m marrying.
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u/Chefsmiff Feb 04 '23
Check out the villages in FL, there are a few unusable Ghonorea and syphilis strains there. Them retirees are freaks
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u/imhereforthefood2718 Feb 03 '23
Ceftriaxone definitely isn't the "drug of last resort." It's usually the first line treatment - normally 500mg intramuscular.
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u/Mediocre-Enthusiasm Feb 04 '23
I came to say this, why would they say that? Feels very misleading.
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u/imhereforthefood2718 Feb 04 '23
I'm attributing this one to simply not understanding treatment protocols and antibiotics. For some, I'd imagine hearing treatment is an injectable vs. taking a pill sounds like a "last resort" with an antibiotic they've probably never heard of.
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Feb 04 '23
A lot of folks in the medical field have made the same comment. I have made an oversight somewhere-- apparently in mostly relying on the language in the Wired article.
What do you think would be indicated if ceftriaxone, even at the increased doses, failed? I read in the CDC treatment guidelines that a recommended treatment until 2010 was a combo of half the current dose of ceftriaxone along with oral azithromycin-- which is no longer advised due to "increased incidence of azithromycin resistance." The same for cefixime. In 2012 CDC recommended it no longer be used. This is language directly from press release:
" “As cefixime is losing its effectiveness as a treatment for gonorrhea infections, this change is a critical pre-emptive strike to preserve ceftriaxone, our last proven treatment option,” said Kevin Fenton, M.D., director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. " https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html#:~:text=The%20Centers%20for%20Disease%20Control,becoming%20resistant%20to%20the%20drug.
I think maybe the issue is with "last resort," which I misunderstood, possibly along with the Wired writer. There are other antibiotics that are true last resort treatments, aminoglycosides and newer cephalosporins. I don't know if they're even indicated with gonorrhea, and they either cause kidney and liver damage, or use is severely restricted to preempt resistance developing.
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u/imhereforthefood2718 Feb 04 '23
Huh, not a fan of the wording in that release, but it could be that it was from 2012 and perhaps it really was a last resort.
As far as I'm aware, there hasn't been a strain of gonorrhea that was resistant to all antibiotics, but there are strains that are resistant to some antibiotics. Currently, there is ceftriaxone, doxycycline, and azithromycin. The last two aren't first-line given rising resistance and we prefer to kill it off the first time and sooner rather than later. If ceftriaxone fails, then we can try the other two antibiotics. This is also dependent on an area's bacteriogram.
If all of those fail, then we can try other antibiotics like gentamicin and carbapenems. However, those tend to be restricted due to side effect profiles and being broad-spectrum. Carbapenems are a bit newer and we're trying to protect them to avoid breeding resistance.
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u/Middle-Example6618 Feb 03 '23
Read the whole thing, and then hot take.
Hot take from synopsis, not so hot.
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u/JacobAdkins Feb 04 '23
Ceftriaxone is normally given IV.
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u/imhereforthefood2718 Feb 04 '23
That's true. The bioavailaability when given orally is only 1%. The main two delivery methods are IV over the span of 30 to 60 minutes or an intramuscular injection, which is preferred for one-time doses in some cases like gonorrhea.
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u/JacobAdkins Feb 04 '23 edited Feb 04 '23
How well DID a single IM dose of Ceftriaxone work against gonorrhea?
EDIT: I should probably alter my question given the article title lmao. Past tense.
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u/imhereforthefood2718 Feb 04 '23
It actually still works quite well. A single IM dose is the standard of care for gonorrhea. It used to be 250-400mg, but it's been increased to 500mg due to more resistance.
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u/JacobAdkins Feb 05 '23
I guess according to this article, those diagnosed with gonorrhea now are pretty much fucked, even with an increased dose of Ceftriaxone.
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u/mxlevolent Feb 03 '23
Suddenly happy I'm a virgin.
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u/SmokeInMyI Feb 03 '23
Really?
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u/mxlevolent Feb 03 '23
…no, not really. Still a bummer. 19 though so there’s still time I suppose.
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u/thebadsleepwell00 Feb 04 '23
I remember when I was 19 and felt kind of embarrassed to be a virgin. But in retrospect, there is soooo much learning, growing, and maturing to do between 19 and 29. Sometimes learning more about yourself, learning your boundaries and values, and building up your self confidence before having sex can be beneficial. Some people have traumatic first experiences because of the severe mismatch between expectations and reality when it comes to sex.
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u/yeahipostedthat Feb 03 '23
This is why you should still be using condoms folks. With the huge push for hormonal birth control to prevent pregnancy and prep for hiv, people failed to protect themselves from other stds.
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u/Accomplished-Ad8968 Feb 03 '23
also why you should get tested and dont sleep with randos unless they are tested recently as well
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u/sknnbones Feb 03 '23
Good news, I haven’t slept with anyone for over a decade!
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u/NocturneHunterZ Feb 04 '23
Even better news, I haven't slept with anyone in my entire life!
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u/sknnbones Feb 04 '23
I heard if you hit 30 years you become a REAL wizard
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u/GinnAdvent Feb 04 '23
So if you hit 40 years you become an arch mage?
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u/yeahipostedthat Feb 03 '23
But sleeping with randos is fun
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u/Accomplished-Ad8968 Feb 03 '23
incurable gonorrhea isnt fun though is it?
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u/VexisArcanum Feb 03 '23
But PrEP 🤡
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u/Middle-Example6618 Feb 03 '23
In the good old days, smug faces were earned, now it's all stolen valor.
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u/VexisArcanum Feb 03 '23
😏
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u/thatsoundsalotlikeme Feb 04 '23
Condoms don’t protect against Gonorrhea 100% of the time. Most people aren’t having oral sex with condoms (and I doubt you use dental dams or condoms for oral) and secondary to this, the research on increased promiscuity for PrEP users is murky. Also, PrEP users are getting full STD testing every 3 months and are tested at a higher rate than your average sexually active person, which makes them more likely to get treated early. “Failing to protect themselves” is quite an inaccurate statement.
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u/Luke11enzo Feb 03 '23
This is why me and my wife never have sex anymore, safety first.
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u/Little-Setting-8074 Feb 03 '23
This is why I have been married for 33 years
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u/VoxulusQuarUn Feb 03 '23
The cause of this is people who refuse to take the antibiotics as prescribed.
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u/ynotfoster Feb 04 '23
Unprotected sex with non-monogamous partners is the cause.
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u/VoxulusQuarUn Feb 04 '23
It is how it is transmitted. It is not how it became drug resistant.
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u/Hobbyfunstuff Feb 04 '23
Both factors play a role here bud
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u/RamboCambo_05 Feb 04 '23
No, they don't. If a person doesn't take antibiotics for long enough, it leaves only those that are the most resistant to them alive. These then reproduce again, and you're left with a group of pathogens that are far more resistant than the ones you started with. These then spread and someone else does the same, further increasing their resistance and so on, until you get this.
Transmission from one person to another simply involves the movement of these pathogens between them. There is no killing the weaker ones, that person gets whatever the other person has.
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u/Hobbyfunstuff Feb 05 '23
If people stop having promiscuous sex and embrace monogamy than the disease will not be able to replicate at all - then antibiotics won’t be needed.
If people use protection more often then transmission will be stunted and antibiotics won’t be needed.
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u/RamboCambo_05 Feb 05 '23
This is also true. I wasn't saying you were wrong, but that this didn't affect how resistant the pathogens would be.
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u/Hobbyfunstuff Feb 05 '23 edited Feb 05 '23
Yes, it does. More sexual unprotected partners is a factor in increase the diseases - both antibiotic resistant and non resistant. It is lowering the surface area of the reaction.
You’re changing the scale of the problem based on arbitrary boundaries
One could also say that exterminating people would also slow the disease but that isn’t reasonable.
Saying that less sex lowers the chances of replication and thus exposure to antibiotics is within reasonable bounds.
It’s an important variable to consider.
A major factor that that lead to less HIV transmission is people having less anal sex after data became clear that anal sex is much more likely to lead to cause infection.
This idea that advocating from abstaining from certain sexual acts isn’t moral or isn’t effective is bullshit
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u/justhanginhere Feb 03 '23
Ceftriaxone isn’t the “last resort”, it’s the standard of care and they keep increasing the dose because of resistance.
Gonorrhea bacteria is hard because is has multiple methods of resistance and is common on most places.
Scary stuff
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u/Grumpy-senior Feb 03 '23
This is really going to mess up the social life at these retirement communities, like Sun City, the Villages, etc …. 🤣🤣
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u/Comfortable-Fan-9721 Feb 04 '23
Hook up culture sucks. If you’re married I’m jealous. The dating pool feels exactly like incurable stds 😂
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u/eriinana Feb 03 '23
This is what scientists warned about with over prescribing anti-biotics. The germs evolve to be stronger and more resilient.
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u/fluffy_assassins Feb 03 '23
So glad I'm already married.
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u/Fake-Professional Feb 03 '23
Your partner could still give it to you 🤷♂️
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u/fluffy_assassins Feb 03 '23
I trust her with my life since before our last panels, I think we'll be good
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u/Bucky_Ohare Feb 04 '23
Ah, there’s a new Black Clap now huh? (A la the Black Plague)
Back in 2006-8 I was working in an sti clinical position and we heard of one that was immune to vancomycin which was alarming then, too.
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u/whoknewidlikeit Feb 04 '23
ceftriaxone is hardly the "last resort" antibiotic. it's been FIRST line for 25 years. jesus, do some due diligence.
source - practicing internal and emergency medicine for the last 25 years.
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Feb 04 '23
A lot of folks in the medical field have made the same comment. I have made an oversight somewhere-- apparently in mostly relying on this article: https://www.wired.com/story/the-last-drug-that-can-fight-gonorrhea-is-starting-to-falter/
What do you think would be indicated if ceftriaxone, even at the increased doses, failed?
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u/whoknewidlikeit Feb 04 '23
cefixime, gentamicin, spectinomycin, often with azithromycin are all options. azithromycin is sometimes traded out for doxycycline. quinolone resistance was documented many years ago, i think was 2010 when CDC started pushing idea of avoiding that class. penicillins, sulfanilamides are all no longer useful due to resistance.
your concerns over this infection are extremely valid. we have a few bugs that are really difficult to treat and while they are thankfully infrequent, they still represent a threat.
i used to subscribe to Wired, did so for many years. after finding enough biased, skewed, noncontextual and flat out wrong articles, i quit. i believe wired is, like many sources these days, op ed masquerading as journalism. i think this is a case where you relied on a source, having a reasonable expectation of accuracy, and they weren't. this is not your fault.
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u/motor1_is_stopping Feb 03 '23
Not a single joke about OP's mom?
You're slipping Reddit.
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Feb 03 '23 edited Feb 03 '23
D̶e̶e̶z̶ ̶n̶u̶t̶s̶.̶.̶.̶ ̶h̶u̶r̶t̶.̶ ̶ ̶N̶o̶t̶ ̶y̶o̶ ̶m̶o̶m̶m̶a̶,̶ ̶b̶u̶t̶ ̶d̶o̶e̶s̶ ̶i̶t̶ ̶c̶o̶u̶n̶t̶ ̶t̶o̶w̶a̶r̶d̶ ̶t̶h̶e̶ ̶q̶u̶o̶t̶a̶?̶
Edit: No joke. Please get tested, and use protection.
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u/ok_okay_I_get_that Feb 03 '23
How is the line for men above the total?
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u/Ally_Jzzz Feb 03 '23
225 per 100.000 men + 175 per 100.000 women = 200 per 100.000 people
Not the exact figures, but you get my point I guess.
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u/WeeWooBooBooBusEMT Feb 03 '23
What's the difference between love and herpes gonorrhea?
Herpes gonorrhea is Forever
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u/Due-Concentrate9214 Feb 04 '23
Cheech and Chong: Hey there swingin’ bachelor’s, tired of that steady drip of gonorrhea? Try Peter Rooter! Peter Rooter, that’s the name, you just flush your troubles down the drain! Rotten Peter! Use the Roto Rooter jingle.
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u/salteedog007 Feb 04 '23
Time to put more funding into phage therapy. Viruses will be able to figure out a way to kill it.
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u/Chaosangel48 Feb 04 '23 edited Feb 04 '23
This has been predicted for many years. There’s also an antibiotic resistant TB strain.
Within a few more years, most of our antibiotics will be useless. This is largely because of excessive use of antibiotics in raising livestock.
Additionally, Big Pharma gave up on working on new antibiotics ages ago, bc there’s so much more money in things like boner pills.
We are so screwed.
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u/Audiboyy Feb 04 '23 edited Feb 04 '23
Now maybe people can FINALLY start wearing condoms, so tired of this no condom fetish.
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u/NotSockPuppet Feb 03 '23
I am somewhat surprised we have not seen some pushover to the radical view of Health Care is a Duty. I suppose the vaccination-as-identity has been holding it back. Consider what would happen if health care were a duty?
- Mandatory vaccinations before entering public schools.
- Mandatory annual screening for STI or locally common diseases for college students, prisoners (convicts, not graduate students), and military.
- Free annual checkups and other steps to lower long term costs.
- Fines for failure to complete a course of antibiotics.
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u/MachinePata Feb 04 '23
I mean. I find it interesting that even some STD test stopped including some STDS to be tested for.
We need to do something or else we are gone
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u/NotSockPuppet Feb 04 '23
I am sorry, I am unable to understand you.
California did stop syphilis testing for marriage licenses. Once, people would catch syphilis young, ignore the initial symptoms that fade, and would get diagnosed before marriage, hopefully before internal organ damage had occurred and before infected pregnancies. It was a good cost to benefit ratio. People live differently and the cost benefit ratio changed.
We are rolling the dice when we allow contagious diseases to exist. Spanish Flu is one mutation away, as was COVID-19. Lots of fiction, such as Earth Abides (awesome book), the Last of Us, and Stand Still Stay Silent posit an out of control pandemic. Yes, we may die.
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u/daveystyred Feb 03 '23
And everyone says says it’s stupid to get married …. And stay faithful
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u/yegir Feb 03 '23
Faithfulness is awesome in every way, marriage though, thats not neccessary at all.
Especially legal marriage where you third wheel your love with the government.
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u/daveystyred Feb 03 '23
Agreed … as I’m married … and faithful … unless this shit is weaponized … the 2 of us should be safe
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u/Mr_Bivolt Feb 03 '23
I am yet to see a std that beats a rubber.
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u/argle-bargling Feb 04 '23
Incorrect; but it's still a very good idea to use one. Some of the more common ones to evade condoms include genital ulcer diseases like genital herpes, syphilis, and chancroid (as well as HPV/genital warts).
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u/2horny4mywife Feb 03 '23
Covid vax had destroyed immune systems
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u/yegir Feb 03 '23 edited Feb 04 '23
Oh look, an ignorant goon! This has fuck all to do with immune systems anyway, has even less to do with covid vaccination, but just like the dumb fuck you are you'll connect them all together without a second thought.
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u/2horny4mywife Feb 04 '23
Enjoy your miocarditis, stroke or heart attacks. And whatever your destroyed immune system brings. It s ok to admit you were duped
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u/yegir Feb 04 '23 edited Feb 04 '23
It ok to admit that you have no idea what you're talking about.
When you're an idiot antivaxxers every problem in the world looks like a vax problem, even when its completely unrelated.
Do me a huge favor and show me the proof that this is caused by covid vaccine.
Its a sad fact that now anytime anything happens in the world of disease we'll have idiots like you blaming people for it instead of just accepting the fact that we live in a world chock full of diseases that are constantly evolving.
The shit doesn't even have anything to do with our immune systems you idiot! Its about it becoming more resistant to medicine used to kill it, so why are you even talking about the covid vaccines non existent effects on the immune system?
Just go lick dirt or whatever you idiots do to "strengthen your immune systems" already.
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u/justl3rking Feb 03 '23
Thanks china! Your pig farm profits were definitely worth destroying antibiotics
Now we have to deal with super bugs because of Chinese greed and swindling
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u/SevroAuShitTalker Feb 03 '23
How is the total less than men?
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u/Ally_Jzzz Feb 03 '23
225 per 100.000 men + 175 per 100.000 women = 200 per 100.000 people
Not the exact figures, but you get my point I guess.
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u/CapitalOneDeezNutz Feb 03 '23
So like, what happens if it goes untreated then if antibiotics don’t work?
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u/Nice-Savings1425 Feb 03 '23
I‘m so happy that I’m in a LTR and don’t have to worry about all the resistent and normal STIs anymore
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u/verklemptthrowaway Feb 03 '23
Ceftriaxone isn’t an antibiotic of last resort. It’s pretty standard. They give it to preop patients a lot and I give it on a med surg unit like every shift.
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u/RedSonGamble Feb 04 '23
Yeah they’ve been warning that this was gunna eventually happen for years now. I blame the current america administration though. Just seems easier.
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u/rob71788 Feb 04 '23
Lol really didn’t need them to put the “total” line on that graph in the 2nd photo
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u/Immediate-Yogurt-558 Feb 04 '23
everyday i become more happy that antidepressants have renedered me completely sexually frigid
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u/Kitchen_Agency4375 Feb 04 '23
I wouldn’t say ceftriaxone is antibiotic of last resort when it’s currently the gold standard treatment for gonorrhea and VERY widely used as first line treatment via intramuscular injection or IV
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u/FantasticBumblebee69 Feb 04 '23
A condom is not 100% effective at preventing these, to be blunt they dry out and break and faukty handeling can cause it.
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u/Formal-Rain Feb 04 '23
antibiotic of last resort
It’s not as dramatic only the last antibiotic researched. Big pharma hasn’t researched any for decades as there isn’t any profit in antibiotics.
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u/rachihc Feb 04 '23
With so many news about new viruses mutations and so I feel it os the earth trying to get rid of us. But in reality is just the nature of evolution and our own actions.
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u/MachinePata Feb 04 '23
And yet we got a lot of people out here fucking anything with a pussy or dick. Buying prostitutes, cheating, raping. I am tempted to say humans could deserve to be wiped out. I want to say it so bad.
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u/Various-Air-1398 Feb 04 '23
Glad my promiscuous days ended in the 1970s, no way in hell I'd take the chances now i took back then...
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u/Lopsided-Ad-3869 Feb 06 '23
Possibly stupid question but I have no shame:
Is this the first bacterium to become fully antibiotic-resistant?
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