Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.See all posts »
Untreatable Gonococcal Infection
Why discuss a sexually transmitted disease in a column about outdoor health? The reason is because we were all young once, many of you are young now, and I know that travelers to exotic locations who are on vacation, out of their daily routines, and in the spirit of adventure are prone to sexual encounters.
We know how venereal diseases are transmitted. That knowledge does not completely stop their transmission, because people do not practice safe sex, are unaware of or ignore risks, or otherwise put themselves in the path of harm from spirochetes, bacteria, and other microbes that invade the procreative and recreative processes.
We can now add untreatable gonococcal infection to the list of sexually transmitted diseases (STD) emerging. In an alarming article in the New England Journal of Medicine (2012;366:485-487), Dr. Gail Bolan and colleagues state, “During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae.”
What is happening here? Gonorrhea ranks number two in commonly reported communicable disease in the U.S., and is prevalent around the globe. It is unquestionably a sexually transmitted disease – you don’t get it from drinking the water. This bacterium has shown the ability to relatively rapidly adapt to the drugs we throw at it, having developed resistance to sulfanilamide, penicillins, tetracycline, and fluoroquinolones. It is now showing resistance to the current recommended treatment regimens that include cephalosporins. When that happens, experts don’t know precisely where they will turn next for effective treatment. For readers who have seen the movie Contagion, we’re not in that sort of a situation (e.g., rapidly fatal disease that will kill hundreds of millions of persons), but it could still become a nasty slog, particularly for the unfortunate persons who become infected. Gonorrhea is not a trivial disease, and can lead to serious medical complications.
In the U.S., it is still recommended to treat gonococcal infections with an intramuscular dose of 250 mg of ceftriaxone, as well as administer a one-gram dose of azithromycin to cover other germs, such as Chlamydia, that frequently accompany the gonococcus. Cefixime is used when ceftriaxone cannot be used, and doxycycline may not be as effective as it has formerly been. When ceftriaxone or cefixime are not used, then the alternative is to use azithromycin, but the gonococcus is becoming resistant to this drug.
So, you get the picture. Using antibiotics to treat diseases always creates the risk of inducing resistance to therapy, as the germs adapt to thwart these therapies and survive. Prevention is better than treatment, so when you are adventuring in the great outdoors, please don’t exceed the boundaries of safe sex.
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