There's A New Treatment-Resistant STI, Arm Yourself With Knowledge

This is the first part of a three-part series on this particular STI, how to talk to partners about safer sex methods and testing, and how to obtain testing. Keep an eye out in the next few weeks for the other two parts, which will also be linked here. 

Before I get into this, I want to be clear about something. Stigma is a big part of why people have trouble accessing health care when they contract something. Shaming individuals as being dirty, unlovable, and more terrible things contribute to the problem. Many people ignore symptoms, and not all STIs, including the one I'll be discussing here, present symptoms, but can still be contagious. Many people don't access regular testing, an important part of any healthy sex life, due to stigma and shame. People who have STIs and who arm themselves with knowledge about their condition, get tested regularly, and get treatment can have fulfilling and relatively normal sex lives. Stigma and shame are the reason some people don't get tested and don't get help until things become too serious to ignore.

Illustration by Caitlin Murphy, based on a photo from the early 20th century. 

Illustration by Caitlin Murphy, based on a photo from the early 20th century. 

That aside, an important aspect of STI prevention and treatment is knowing what we're dealing with, so buckle up friends because I'm about to bring you on a journey. 

Many of us have heard of gonorrhoea, it's a common enough and well known STI that has generally been easily treatable since antibiotics came into popular use in the 1940s. Historically, gonorrhoea has a long history: some translate biblical hebrew words zav (the male version, Hebrew is highly gendered) and zavah (the female) as representing the disease, and laws in medieval England and France, in the 12th and 13th centuries, reference "the burning" which is believed to use a common symptom of the disease as a descriptor. The still-common nickname for the disease, "the clap" is traced back to as early as the 15th century. 

Gonorrhoea as we know it is fairly straightforward. It can be transmitted through mucous membranes in the mouth, vulva, vagina, anus, and penis. Not everyone has symptoms, but vulval symptoms usually include vaginal discharge, lower abdominal pain, or pain with sexual intercourse that is associated with inflammation of the cervix. Penile symptoms include inflammation of the urethra, burning during urination, and discharge from the urethra, with discharge being the most common symptom, often unaccompanied by the burning sensation. Oral gonorrhoea does not induce symptoms in 90% of those infected, with the additional 10% experiencing a sore throat. When untreated, this STI can result in a variety of ailments, including overall tiredness, joint pain, and an allergic reaction to the bacteria. More rarely, it can travel to the heart and cause endocarditis, or the spine, causing meningitis, but this is unlikely to happen outside of people suppressed or weakened immune systems. 

Generally, treatment in the modern era has involved antibiotics, beginning with penicillin. Unfortunately, the World Health Organization (WHO) has warned that the bacteria is getting smarter. These clever bacteria are becoming more difficult to treat, and in some cases, impossible to treat. One of the fascinating things about bacteria (not all of them are bad, and we even rely on thousands, if not more, of varieties to maintain bodily function and health), is how adaptable they are. Unfortunately for us, gonorrhoea is no exception: 

The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.
— Dr Teodora Wi, Medical Officer, Human Reproduction, at WHO

WHO is currently reporting widespread resistance to older and cheaper antibiotics, which poses a particular risk for spread of the disease in poor communities and less industrially developed countries, which is exactly where STIs like gonorrhoea hit the hardest. However some countries, particularly those with higher income where surveillance is best, are reporting cases of the infection that are untreatable by any known antibiotics. In short, the bacteria is out-smarting us, and adapting to everything we throw at it. 

The WHO also noted in their report that women (or, people who come with "built-in" vulva and/or uterus) are particularly vulnerable to the complications that can result: "including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV." 

The causes, according to their statement, include "Decreasing condom use, increased urbanization and travel, poor infection detection rates, and inadequate or failed treatment all contribute to this increase." 

To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures.Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on that particular infection – and longer term, a vaccine to prevent gonorrhoea.
— Dr Marc Sprenger, Director of Antimicrobial Resistance at WHO

What do they suggest? Personally, you can use safer sex practices such as barrier use and testing, as well as gaining and spreading awareness. If you want to meet and fuck new people or if you're non-monogamous with your partners, and just in general: use barrier methods and get tested regularly. On a public level, WHO is calling for more awareness from health care professionals and more research.

"There are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea. Many people who are infected with gonorrhoea do not have any symptoms, so they go undiagnosed and untreated," WHO said in their report. "On the other hand, however, when patients do have symptoms, such as discharge from the urethra or the vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even though people may be suffering from another kind of infection. The overall inappropriate use of antibiotics increases the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases."

In short, advocating for and learning how to get tested, demanding testing if your doctor thinks you might have gonorrhoea before agreeing to taking antibiotics, and general awareness is paramount to staving off a potential epidemic with lasting and serious ramifications. Learning how to use barriers and use them more often is the first step you can take. I'll discuss how to have conversations with partners about testing and barrier use in part two, which I'll link here when it goes live. 

"Today, lack of public awareness, lack of training of health workers, and stigma around sexually transmitted infections remain barriers to greater and more effective use of these interventions." You heard that? Educate yourself and others, and don't blame people who have contracted this or another STI. Cultural shame and lack of comprehensive education are at fault, not individuals.  

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