A New Super Villain: Gonorrhea?

We used to call it venereal disease. Many preferred the more common term: "The Clap." Eventually, a more appropriate term evolved: sexually transmitted disease. Recently, the term "disease" has been exchanged for "infection." Whatever name it was called, we all knew that Gonorrhea, while embarrassing and painful, was also curable. In other words, many felt that is was just a minor inconvenience.

Now comes new information that a strain of Gonorrhea may be evolving into a "superbug," a drug resistant bacteria that will be much harder to treat. Speaking at the Society for General Microbiology’s spring meeting in Edinburgh, Scotland, Catherine Ison, a microbiologist with the Health Protection Agency in London, reported that the bacteria Neisseria gonorrhoeae has become multi-drug resistant and threatens to make the STI more and more difficult to treat. Gonorrhea infects approximately 700,000 Americans a year, with the highest infection rates in the U.S. among teens, young adults and African Americans, according to the Centers for Disease Control and Prevention. Gonorrhea can infect the eyes, throat and mouth as well as male and female genital areas. For decades it has commonly been treated with first tier antibiotics such as Penicillin. Now, even newer medications such as ceftriaxone and cefixime may be becoming less effective. According to Dr. Ison, "choosing an effective antibiotic can be a challenge because the organism that causes gonorrhea is very versatile and develops resistance to antibiotics very quickly."

Multi drug resistance is not a new phenomenon. We have struggled with it for years in HIV treatment, as well as in treatment a variety of infections such as Staph, MRSA, and Campylobacter Bacteria (one of the most common causes of diarrheal illnesses in humans). One potential culprit to this phenomenon is the increase of antibiotic use in farm animals. Recently, "major increases in antibiotic-resistant bacterial infections in human populations have led to public health concerns regarding antibiotic use for non therapeutic purposes (i.e., not used to treat disease) in animals destined for food production," according to a statement by the Pew Charitable Trusts. "Bacteria are able to develop antibiotic resistance when exposed to low doses of drugs over long periods of time. To promote growth and weight gain, entire herds or flocks of farm animals are routinely fed antibiotics and related drugs at low levels in their feed or water — a practice that has been identified as a major contributor to antibiotic resistance."

Gonorrhea is often asymptomatic in women and can be mistaken for a bladder or vaginal infection with symptoms such as painful urination and vaginal discharge. Men may experience a burning sensation when urinating as well as painful or swollen testicles. Untreated gonorrhea can cause infertility in both sexes, join infection and, when passed by a pregnant woman to her fetus, blindness and a life-threatening blood infection in babies. Moreover, sexually transmitted disease can make one more vulnerable to HIV infection.

Yet, as with most sexually transmitted infections, Gonorrhea is 100% preventable. The answer is not rocket science. It's about making better choices, knowing one's partner, getting screened for STI'S and good old fashioned safe (abstinence) and safer (condoms, dental dams, etc) sex.

African American Women and STI'S

Recent news has not been kind about women and girls of color and their sexual health. In 2008, a Centers for Disease Control and Prevention (CDC) study reported that almost one-half of adolescent black females were infected with at least on STI (Sexually Transmitted Infection). Now, new evidence has further documented the impact of STI'S on women and girls of color. According to the CDC, 48 percent of black women between ages 14 and 49 have the virus which causes genital herpes. Blacks in general are more than three times as likely as whites to have herpes simplex virus type 2 (HSV-2) (39.2 percent vs. 12.3 percent). Biological factors make women more susceptible to genital herpes than men. American women in general are nearly twice as likely as men to be infected (21 percent vs. 11 percent). Moreover, up to 80 percent of genital herpes infections in the United States are undiagnosed.

The news is no better on the local front. A recent report from the Philadelphia Department of Public Health revealed a dramatic 238% increase in primary and secondary cases of Syphilis in females. Many of the cases in females occurred in adolescents and young adults aged 15-24 years old.

The high rates of genital herpes infections and syphilis, as well as other STI'S among women of color, may contribute toward the high rate of HIV in the black community by making transmission easier. In 2007, more than 25% people infected with HIV in the United States were among women and girls aged 13 years and older. More than 278,000 women and adolescent girls in this country are living with HIV. For female adults and adolescents, the rate of HIV/AIDS diagnoses for black females was nearly 20 times as high as the rate for white females and nearly 4 times as high as the rate for Hispanic/Latino females.

Last year, the CDC implemented new guidelines to encourage HIV testing to be a part of routine medical care. Clearly, sexually transmitted infection screening should also be a part of this routine care. Significant progress in reducing the spread of HIV in Sub-Saharan Africa has been made by preventing, diagnosing and treating STI's. It's time we apply these priorities in this country, especially in women and girls of color.