With the Centers for Disease Control and Prevention calling it an “epidemic” and without the demand for pharmaceutical companies to produce new drugs, the U.S. could see antibiotic resistance to sexually transmitted diseases in the next five to 10 years — and young people on college campuses are especially prone.
Antibiotic resistance is the ability of bacteria to resist the effects of the drugs used to treat them. Meaning, the bacteria are no longer killed by a drug that used to kill them before, and the bacteria are then free to keep multiplying, according to recent reports released by the CDC.
“The gonorrhea organism is very adaptable and very smart,” said Candy Hadsall, a prevention nurse specialist at the Minnesota Department of Health. “So every time it [is introduced to] a new drug, it starts working to figure out how to get around it.”
This has been the case throughout history, as gonorrhea has become resistant to medications like penicillin and other previous treatments.
There have not been any documented cases in the U.S. of antibiotic resistance to gonorrhea when the recommended treatment has been used. However, both the U.K. and Canada have seen cases of the infection that could not be treated with the commonly applied antibiotics. The CDC recommends a single shot of ceftriaxone and an oral dosage of azithromycin.
Yet lab studies have found resistance to previously recommended treatments, and antibiotic resistant gonorrhea is listed as one of only three "urgent" threats on the CDC’s website.
Among University of Minnesota students who have been sexually active within their lifetime, 9.3 percent reported being diagnosed with a sexually transmitted infection, with chlamydia being the most commonly diagnosed, according to the most recent student survey released by Boynton Health in 2015.
More than two million cases of chlamydia, gonorrhea and syphilis were reported in the U.S. in 2016 — the highest number ever, reports the CDC. Nationally, gonorrhea has seen 67 percent increase since 2013, according to data from the CDC.
“We know that’s only a fraction of the sexually transmitted infections that occur, because some [have no symptoms] and they never get diagnosed or reported,” said Elizabeth Torrone, an epidemiologist in the CDC division of STD prevention. “And some STIs are not reportable conditions.”
There have been considerable increases in reported STDs over the past five years, especially gonorrhea, Torrone said.
The reasons for the increase are varied. Potential causes are a mixture of changing sexual practices and that more people are getting screened and treated. But such drastic increases, especially with gonorrhea, suggest that more people being screened cannot account for the increase alone, said Torrone.
People of color, as well as young women between the ages of 15 to 24, are disproportionately affected by STDs, but are also the least likely to know they are infected. The majority of women do not develop symptoms when they develop gonorrhea, which can result in not seeking medical care. Untreated sexually transmitted infections and diseases can lead to long term complications such as infertility and pelvic inflammatory disease, ectopic pregnancies, and can in rare cases result in death if untreated.
With the increase in drug-resistant STDs, pharmaceutical companies are pushed to develop new medications. However, there isn’t enough money to be made in STDs, Hadsall said.
There is another oral medication that works against gonorrhea – cefixime – but after one company’s patent expired, the company decided to cease its production. Now, the only company that makes the oral medication is located in India, and they can charge any price they choose, she said.
“Some places pay $20, some pay $100 just for a capsule,” Hadsall said. As a result, many pharmacies are no longer stocking the medication.
It’s critical that individuals and communities take steps to fight antibiotic resistance, Torrone said.
“We’re taking a multi-pronged approach to prevent the emerge of resistance,” she said.
At the University, young people should make sure to get tested annually and use protective barriers during intercourse, said Melissa Koe, a coordinator for the Sexual Health Awareness and Disease Education group. SHADE is a peer health student group run out of Boynton Health and a resource to University students.
“We make sexual health supplies and knowledge more accessible and reliable to students,” Koe said.
Organizations like the CDC and the Minnesota Department of Health are working on surveying the problem to make sure that the most effective treatment is being recommended for the strains circulating a community.
“We also work closely with health care providers to make sure people most at risk for STIs like gonorrhea are being screened as well,” Torrone said.