Saturday, September 21, 2013

The new 'gift that keeps on giving'

You've all undoubtedly heard of the dreaded Herpes simplex II (genital herpes) infection being referred to as 'the gift that keeps on giving.'  Owing to its propensity for recurrence, for the rest of your life.  Merry Xmas, you've got the herp!  Well, gonorrhea has stepped up to join in the party.  Drug-resistant Neisseria gonnorhoeae has been named as one of three bacterial organisms at Threat Level: Urgent by the Centers for Disease Control and Prevention (CDC).  This organism is described as "an immediate public health threat that requires urgent and aggressive action".  You can read the full antibiotic resistance threat report here.  Over the years as antibiotics have been used, and used, and overused, and misused, Neisseria gonorrhoeae, the causative agent of gonorrhea, has been working up resistance.  Most bacteria that are barraged with chemicals meant to disrupt their growth and reproduction evolve rapidly to counteract or resist those very chemicals.  N. gonorrhoeae infection in previous decades was easily cured; a little penicillin and you were good to go.  Then ten, twenty years ago, maybe you needed a little more penicillin for a longer time frame.  Then maybe you had to go back to the clinic because lo and behold you still had gonorrhea.  It was really cramping your style.  So your doc prescribed a different antibiotic and you went on your merry way.  Now you have gonorrhea?  In 2013?  Good luck.  Also, maybe pick up some condoms at the pharmacy next time you're there! 

So you may ask yourself, how does one find out if one's gonorrhea will be resistant or susceptible to the prescribed antibiotic?  Your care provider must collect a specimen; a swab of pus or one that is inserted in the urethra.  Ouch!  That swab needs to either be inoculated directly onto certain plated agar media or placed in special transport media and sent immediately to a lab that performs cultures for N. gonorrhoeae.  Unfortunately, there are not many microbiology labs that perform these cultures anymore.  And fewer still that would have the capability to perform antibiotic susceptibility testing.  I happen to work at one, but we only receive a handful or less of N. gonorrhoeae culture requests each week.  The vast majority of testing for gonorrheal infection is done by nucleic acid amplification testing.   Our lab uses a test that detects specific portions of ribosomal RNA of the organism, if it's present.  This test does not allow for culture and antibiotic susceptibility testing as the organisms are killed and ripped open to get to the rRNA.  Savage as it is, I can tell you if you have gonorrhea in a matter of hours as opposed to days using traditional culture.  So you see, herein lies the problem: as technology increases and becomes less expensive with faster turn-around times than culture, labs move towards the tech.  The pitfall is that without actually growing the organism to perform susceptibility testing, we can't know if the antibiotic selected by a care provider will work.  Eventually technology will catch up and we'll be able to affordably test for antibiotic resistance without needing the living bug, but we're not there yet.  

So what can you do?  Well for starters, use condoms!!  For real.  It's not a big deal and they make cool ones now with all sorts of lubes that make all parties feel all tingly and sexy.  Next, IF you need antibiotics for a BACTERIAL infection (I'm talking to you fools that demand antibiotics for a cold, which is caused by a virus), take the whole dose.  I don't give a rat's behind if you feel better after a couple of days.  Take all of the meds.  Don't save some for the next time you feel icky.  Don't give half to your friend.  Seriously.  Finally, pass this on.  This post, not the drug-resistant gonorrhea.