The World Health Organization (WHO) is warning about the potential rise in antibiotic-resistant gonorrhea — also known as “super gonorrhea” — due to overuse of antibiotics during the COVID-19 pandemic. The news, delivered to British newspaper the Sun via a WHO spokesperson, elicited both concern and humor on social media Monday.
Specifically, the spokesperson mentioned a frequently prescribed antibiotic known as azithromycin, and said that, overall, “overuse of antibiotics in the community can fuel the emergence of antimicrobial resistance in [gonorrhea].” But what is super gonorrhea, and is it something to worry about in the U.S.? Here’s what you need to know.
It’s a type of gonorrhea that’s proven resistant to the drugs used to treat it
Gonorrhea is a sexually transmitted disease that affects more than 1 million Americans per year. Super gonorrhea refers to strains of the STD that do not respond to common antibiotics. The first cases of super gonorrhea appeared in Japan in 2011, but antibiotic resistant strains have since spread to many countries, including the U.S. The Centers for Disease Control and Prevention (CDC) hosts an information page on super gonorrhea saying that it has “quickly developed resistance to all but one class of antibiotics” and that as many as half of new gonorrhea infections are resistant to at least one antibiotic.
Dr. Bruce Y. Lee, a professor of at CUNY School of Public Health & Health Policy, predicted the arrival of super gonorrhea to the U.S. in a 2018 op-ed for Forbes, following the first case in the U.K. Speaking with Yahoo Life, Lee says that super gonorrhea is one of many “super bugs,” or strains of bacteria that become resistant to the drugs used to treat them. “In 2017, the WHO published a list of bad superbugs and drug-resistant gonorrhea was one of them,” says Lee. “So it’s always been a concern.”
Azithromycin, a standard treatment for gonorrhea, has been prescribed frequently during the pandemic
Lee says concern about an impending rise in super gonorrhea stems from the use of a specific antibiotic called azithromycin. A broad-spectrum antibiotic (meaning it’s an effective treatment for many conditions), azithromycin was prescribed early on in the pandemic due to its success with pneumonia. But Lee says its use significantly increased after some experts suggested that it be used in combination with hydroxychloroquine, an immunosuppressant that doctors have since been discouraged from prescribing to COVID-19 patients.
“At the time, people were trying all kinds of things — especially anything that may have anti-inflammatory properties,” says Lee. “But basically scientific studies have not found benefit of adding azithromycin to standard of care for patients hospitalized with COVID-19.”
Two weeks ago, the CDC changed its guidelines for how to treat gonorrhea
While no official data has been published showing an increase in super gonorrhea in the U.S., Lee points to a Dec. 18 study published in the CDC’s Morbidity and Mortality Weekly Report, which revealed that cases of azithromycin-resistant gonorrhea have increased more than seven-fold in five years.
In the wake of the paper, the CDC removed azithromycin as standard of care treatment, suggesting instead that providers give only ceftriaxone — another antibiotic — instead of both. The page now reads: “CDC’s updated recommendations for the treatment of uncomplicated gonorrhea in adolescents and adults: two-drug approach no longer recommended; treat with just one 500 mg injection of ceftriaxone.”
Experts worry that other factors about the pandemic may cause super gonorrhea to spread
“There’s concern about the overuse of antibiotics but the other concern is that because a lot of ‘non-essential’ health services are shut down … that people who may be at higher risk for sexually transmitted infections may not be getting the proper care or taking preventative measures,” says Lee. “They might either not be treating [STIs] or trying to treat themselves using antibiotics they get online or from a friend — and that’s problematic. So that combination is what’s concerning to the World Health Organization.”
He says while it’s too soon to say definitively whether cases are increasing, it is likely. “The CDC did make that change [to their recommendations] because they saw, before the pandemic, a continuing increase in the percentage of drug-resistant strains,” says Lee. “So one would expect that it will be a continuing problem.”
The best ways to stay safe include limiting antibiotic use and practicing safe sex
Lee notes that the COVID-19 pandemic has “unearthed existing problems” in society and that super gonorrhea is no exception. “It’s not like super gonorrhea became a concern just now; it’s been a concern,” he says. “People see the headline every now and then, but then it’ll fade off … but the problem’s still there and it’s getting worse and the solution hasn’t come.”
So what can you do to protect yourself? Lee says first to “be careful with antibiotic use” and try to take them only when necessary. “Any type of antibiotic use is going to drive more resistance,” he says. “A large percentage of upper respiratory stuff is not going to benefit from antibiotics so don’t use them or push for them unless you really actually need them.”
This includes COVID-19. “You may run into someone who is telling you that you should take azithromycin, but keep in mind that there is no evidence that that’s actually going to help you,” he says.
Lastly, he notes that those who believe they may have a sexually transmitted disease should see a doctor (“don’t try to treat it yourself”) and that everyone should practice safe sex. “Use protection, be careful, practice safe sex, et cetera,” he says. “That may sound like less of an issue during a pandemic when people are social distancing, but we still have to remember, not everyone is following those guidelines.”