Wherever you are in the world, time is running out for treating gonorrhea
Mark King has had the clap so many times he's renamed it "the applause. "
The first time King had gonorrhea, he was a teenager in the late 1970s, growing up in Louisiana.
King visited a clinic and gave a fake name and phone number. He was treated quickly with antibiotics and sent on his way.
A few years later, the symptoms reappeared. By this time, the 22-year-old was living in West Hollywood, hoping to launch his acting career.
Los Angeles had a thriving a gay scene where King, for the first time, could embrace his sexuality freely. He frequented bathhouses and also met men in dance clubs and along the bustling sidewalks. There was lots of sex to be had.
Like a few years earlier, the doctor gave him a handful of antibiotics to take for a few days that would clear up the infection. It wasn't a big deal. In fact, as King describes it, it was "simply an errand to run."
But it was the calm before the storm, in more ways than one.
When King picked up gonorrhea again in the 1990s, he was greatly relieved that treatment was now just one dose.
Penicillin was no longer effective, but ciprofloxacin was now the recommended treatment and it required only one dose. In King's eyes, getting gonorrhea was even less of a hassle.
But this was actually a symptom of treatment regimens starting to fail.
The bacteria Neisseria gonorrheae was on the way to developing resistance to nearly every drug ever used to treat it.
A global threat
When Alexander Fleming received the 1945 Nobel Prize in Physiology or Medicine for discovering penicillin, he finished his lecture with a warning: "There is the danger," he told the audience, "that the ignorant man may easily underdose himself and, by exposing his microbes to non-lethal quantities of the drug, make them resistant."
In other words, we have known about bacteria's ability to evolve resistance to drugs since the dawn of the antibiotic era.
"All antibiotics will have a shelf life; that's just evolution," says Dr. Manica Balasegaram. "It's just a question of how quickly it will happen."
Balasegaram is director of the Global Antibiotic Research and Development Partnership, based in Geneva. It's a joint initiative between the Drugs for Neglected Diseases Initiative and the World Health Organization and aims to develop new or improved treatments for bacterial infections.
Antibiotic resistance is one of the biggest threats to global health, food security and development. Common infections, such as pneumonia and tuberculosis, are becoming increasingly difficult to treat.
But the Global Antibiotic Research and Development Partnership has chosen to focus its attention on gonorrhea as one of its four main priorities.
The sexually transmitted infection, or STI, caught Balasegaram's eyes for a host of reasons.
Acquiring resistance quickly
For one, a lot of the antibiotics that are currently used against gonorrhea are used widely for other infections, and N. gonorrheae has the ability to acquire resistance from other bacteria frighteningly quickly, meaning it can rapidly build up resistance.
Secondly, untreated gonorrhea infections bring with them a range of potentially serious health implications that can have devastating consequences.
Every year an estimated 78 million people are infected with gonorrhea, making it the second most frequently reported bacterial STI after chlamydia, according to the WHO.
Gonorrhea can infect the genitals, rectum and throat. Symptoms include discharge from the urethra or vagina and burning during urination called urethritis, caused by inflammation of the urethra. However, many who are infected don't experience any symptoms, meaning they go undiagnosed and untreated.
Complications of untreated gonorrhea can be severe and disproportionately affect women, who are more likely to experience no symptoms.
Untreated gonorrhea not only increases the risk of contracting HIV but is also linked with an increased risk of pelvic inflammatory disease, which can cause ectopic pregnancy and infertility. A pregnant woman can also pass on the infection to her baby, which can cause blindness.
A major concern is that because N. gonorrheae can live in the throat without someone even knowing, the bug can acquire resistance from other bacteria that also live there and which have been exposed to antibiotics in the past. And with evidence that oral sex is becoming increasingly common in some parts of the world, this is particularly challenging.
"People are dying from drug-resistant infections. This is undoubtedly because this area has not been prioritized in the past because other areas of R&D are far more lucrative," Balasegaram says.
"Antibiotics are a global public good. I don't think it's easy to put a financial value to it.