The World Health Organization put out an alert today with regards to an untreatable form of Gonorrhea that seems to be becoming more prevalent. The antibiotic resistant strain of what is commonly regarded as little more than a nuisance STD, easily treated and cured, could set off a medieval style epidemic.

It is estimated that more than 100 million people are infected with the bacteria each year, making up a quarter of all treatable STD infections. The disease colloquially known as “The Clap” causes burning urination and penile discharge in men, while around half of women remain without symptoms, making them ideal hosts and carriers to continue passing on the disease to future partners. It’s also possible to get gonorrhea of the throat from performing oral sex and this also remains asymptomatic in 90% of cases. The bacteria can also be passed from a mother to her new born during birth, sometimes infecting the eyes and producing a swollen crusted appearance to the eyelids.

The standard treatment in modern times was a quick course of ceftriaxone, but with resistance to this antibiotic growing, doctors are beginning to run out of treatment options for some patients. Gonorrhea was seen as a large problem in the middle ages, with reports of the disease going as far back as 1100. Parliaments and Kings passed laws requiring physicians to treat prostitutes infected with “the burning” and in some cases people were banished for being carriers.

Dr Manjula Lusti-Narasimhan, from the Department of Reproductive Health and Research at WHO said in the statement that :

“Gonorrhoea is becoming a major public health challenge, due to the high incidence of infections accompanied by dwindling treatment options … The available data only shows the tip of the iceberg. Without adequate surveillance we won’t know the extent of resistance to gonorrhoea and without research into new antimicrobial agents, there could soon be no effective treatment for patients.”

The WHO is calling for greater vigilance and better use of antibiotics. They also ask for more research into alternative treatments for the disease, which luckily can only be passed on through direct sexual contact and not through a toilet seat or swimming pool. In addition, and in testament to their concern, they call for a Global Action Plan, to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. They are hoping for better prevention, diagnosis and control of gonococcal infections.

To make matters worse, it appears that the bacteria is able to genetically pass on resistance to previously used antibiotics such as penicillin, thus, once the bacteria has resistance that will be retained almost permanently. The extent of the current resistance is not well known, and data is lacking for many countries. A large part of the problem comes down to incorrect use of antibiotics and poor quality or tarnished medicine, although genetic mutations can also create resistance.

In recent years, there has been increasing concern that antibiotic resistance is building to a number of diseases, with superbugs in hospitals, antibiotic resistance Tuberculosis being just one example.

Dr Lusti-Narasimhan concludes the warning stating that:

“We are very concerned about recent reports of treatment failure from the last effective treatment option the class of cephalosporin antibiotics as there are no new therapeutic drugs in development .. If gonococcal infections become untreatable, the health implications are significant.”

In the middle ages, physicians are said to have used mercury injection via the urinary meatus, but by the 19th century, silver nitrate became widely used and later colloidal silver, which was marketed as Protargol by Bayer from 1897 onwards, until the first antibiotics became available in the 1940s. Perhaps researchers would be wise to take another look at the silver nitrate possibility.

Written by Rupert Shepherd