When it comes to sexually transmitted diseases, gonorrhea has long gone in the category of: Well, at least it's curable. Until now.
The disease, which infects 106 million people each year, has increasingly become resistant to antibiotics, with cases now being reported of immunity to the last line of antibiotics left to cure it, the World Health Organization stated in a recent news release.
But gonorrhea isn't the only bug that's outsmarting antibiotics. For example, certain strains of E. coli, a bacterium commonly linked to food-borne illnesses, have become resistant to common treatments. The World Health Organization has reported that 440,000 cases of multidrug-resistant tuberculosis, a form of TB resistant to two key drug treatments, develop each year and cause at least 150,000 deaths. A rarer and more resistant TB strain, called extensively drug-resistant TB, has been found in 64 countries, according to the WHO, which notes the capacity of bugs to spread across the globe.
Transmission of E.coli can occur through something as ordinary as a handshake; TB can spread by a simple cough.
The WHO blames the misuse of antimicrobial medicines like antibiotics, antivirals, and antimalarials for the formation of new types of bacteria, viruses, and parasites that resist current treatments. Think of it like that Whac-A-Mole arcade game, where you pound back one mole only to find another one pops up through a different hole. At stake is not only the welfare of affected patients, but the entire healthcare system.
Antimicrobial resistance "reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others," the WHO stated in an e-mail to U.S. News. "When infections become resistant to first-line medicines, more expensive therapies must be used. The longer duration of illness and treatment, often in hospitals, increases healthcare costs and the financial burden to families and societies...Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy, and major surgery would be compromised."
Already, hospitals have given rise to organisms that withstand every available treatment, says Brad Spellberg, chair and assistant professor of medicine at the David Geffen School of Medicine at UCLA and a member of the Infectious Diseases Society of America's Antimicrobial Availability Task Force, which addresses antibiotic resistance. "Those have returned us to the pre-biotic era."
Hospitals have also provided fertile ground for the transmission of methicillin-resistant Staphylococcus aureus (MRSA), a strain of "staph." There are still antibiotics available to treat MRSA, says Spellberg, but he calls the infection a "tremendous public health problem," with 750,000 Americans contracting the illness each year.
In fact, the migration of bacteria from the hospital to the community has helped drive the spread of antibiotic-resistant bugs, says George Zhanel, a professor in the department of medical microbiology at the University of Manitoba in Canada and director of the Canadian Antimicrobial Resistance Alliance. Fifteen years ago, "we only talked about these antibiotic-resistant superbugs being in the hospital setting," Zhanel says. "These organisms have spread now to the community," he says, explaining that hospital patients are more quickly dispatched to their homes, where they are taking antibiotics and where resistance can form and spread.
But the use of antibiotics is far more pervasive than just prescription treatment. Our food is full of them. "Eighty percent of the antibiotics used in the United States are in animals," Spellberg says, noting that "the vast majority of that is not to treat sick animals," but to grow them large enough to sell them profitably. If the cow ingests antibiotics, and we eat the cow, then—remember the transitive property?—we also ingest those antibiotics. "Thirteen million kilograms of antibiotics per year go into livestock to make them bigger," Spellberg says, "and you wonder why we have antibiotic-resistance problems."