October 2nd, 2012

The Drug-Resistant Gonorrhea: How Much of a Threat?

By now, all ID docs know about the ceftriaxone-resistant Neisseria gonorrhoeae. Or, more accurately, we’ve read about it, since the vast majority of gonorrhea cases are treated in emergency rooms, STI clinics, college health facilities, and various primary care settings — not places that most ID doctors typically work.

Plus, hardly anyone does susceptibility testing or even cultures for gonorrhea anymore, so this “superbug” is quite different from the nasty ICU gram-negative rods or MRSA, which are diagnosed on a daily basis. We know the resistant GC is out there, but it’s kind of like carbon monoxide poisoning — if it’s causing problems, we probably wouldn’t know about it until too late.

All this made me quite interested to read two diametrically opposed perspectives on this latest resistant threat, both from accomplished physician-writers.

Over in the New Yorker, we have Jerry Groopman’s take. A hematologist-0ncologist at Beth Israel Deaconess, Groopman is known in the ID world as one of the pioneers of HIV care and research in early days of the epidemic.

In a piece entitled “Sex and the Superbug,” he takes the view that this drug-resistant gonorrhea is basically the product of 1) our overuse of antibiotics (natch) and, more importantly, 2) our enthusiasm for oral sex, which may not be as “safe” as commonly viewed. Let the “sexually active (or not)” be warned!

By contrast, Kent Sepkowitz, an ID doctor from Memorial Sloan-Kettering, wrote in Slate that all this attention paid to drug-resistant gonorrhea is just a lot of scare-mongering:

But I have to ask, people, why all the excitement? As a looming public-health calamity for John Q Citizen as he walks down Maple Street in Middletown USA, the threat is minuscule (particularly if John Q can remember to keep his pecker in his pants). As with the avian flu massacre that never was and the smallpox pandemic that never came, this Superbug fascination seems to be more about our peculiar love of fear itself (cf: Stephen King, Paranormal Activity, the Republican debates) than any sober consideration of the risk before us.

Both these pieces are quite entertaining and highly recommended. Don’t miss Groopman’s description of historical treatments for GC — yikes — and Sepkowitz is flat out irreverent (and funny!) in a way one rarely encounters in doctor prose.

In the meantime, I can only imagine how terrifying it would be to learn about this drug-resistant bug in high school health class — you know, that day when they “educate” teenagers about the perils of unprotected sex, with the mandatory grisly images.

Health teacher: “OK kids, now here’s one where we basically have no effective treatment.”
Class (all together):  “Ewwwwww!!!”

So what’s your view?

What's your take on the drug-resistant gonorrhea?

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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