Writing about sexually transmitted infections (STIs), one must walk the line between warning readers of risks and engaging in full-fledged alarmism. So it’s a bit disconcerting that researchers writing in the New England Journal of Medicine last month declared that it’s “time to sound the alarm”: The emergence of completely antibiotic-resistant gonorrhea is becoming more of a realistic threat and less of a theoretical possibility. The bacteria that cause gonorrhea are evolving faster than we can develop effective antibiotics against them, and a return to the era of untreatable gonorrhea could see a rise in the particularly nasty complications that arise from a long-term gonorrheal infection, such as pelvic inflammatory disease and epididymitis.
Neisseria gonorrhoeae is a species of tricky bacteria that cause gonorrhea, which can infect the mouth, throat, rectum, urethra, cervix, and even eyes. These bacteria have vexed us for thousands of years, having evolved many strategies for entrenching themselves in our bodies. They can alter the proteins that adorn their surfaces, rendering our immune systems incapable of recognizing them. They can form colonies in which they work together to manipulate our cell surfaces with their retracting appendages until they’re allowed entry inside, where they can surreptitiously multiply.
You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that has acquired resistance to methicillin, as well as pretty much every other antibiotic to boot. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.
Why are we talking about MRSA in a post about STIs? It’s not just because MRSA has apparently found a way to be transmitted sexually, but also because it helps make the concept of antibiotic-resistant gonorrhea more accessible. It wasn’t until less than a century ago that we finally developed a magic-bullet treatment for gonorrhea, and for a handful of decades it was quickly and easily treated with a dose of penicillin. Enter evolution by natural selection. Continue reading