Drug-resistant cases of gonorrhea detected in the US
arstechnica.com
arstechnica.com
Poor treatment adherence/outcomes in these cases would likely increase antibiotic resistance.
From the original report: https://www.mass.gov/news/department-of-public-health-announ...
It's absolutely alarming that a dubious story about viral exposure at a wet market can gain so much undeserved traction worldwide, while the unquestioned use of antibiotics at factory farms elicits barely a word.
A safe and effective vaccine, while welcome and important, only kicks this can down the road - and not very far. The threats of resistant pathogens are difficult to overstate.
Let's start talking seriously about this issue. Please. Tell your friends.
I agree with your other points, but not this one. There are a lot of reasons to believe that a safe and effective vaccine would be more likely to lead to a containment (or even elimination, in the most optimistic case) of gonorrhea rather than just "buying time until things get bad again".
But what it doesn't do is stop the accelerating treadmill of antimicrobial resistance. There are many other bacteria (and, for that matter, other infectious pathogens) that will happily step up to fill the evolutionary opportunity as vaccines inhibit illness from (or even spread of) others.
Those aren't comparable. HPV vaccination needs to be administered to kids because the virus is incurable and is routinely spread to kids/adolescents through nonsexual contact.
A gonorrhea vaccine can be administered only to adults, or to high-risk groups, and still be effective at a population level.
There are obvious propaganda efforts here. Plus dubious though it may be, it's also possible it's the truth. Swineflu happened in similar ways.
> A safe and effective vaccine, while welcome and important, only kicks this can down the road - and not very far. The threats of resistant pathogens are difficult to overstate.
How does it do so? Vaccines appeared to be effective at eradicating polio and smallpox
> Let's start talking seriously about this issue. Please. Tell your friends.
Regardless, I do agree it is a concern.
Totally - and that's why it's important work.
But eradication of a specific pathogen is orthogonal to overcoming the threat of antimicrobial resistance. As long as we're offering super powers to pathogens, somebody will step up and take them.
https://www.cdc.gov/nchhstp/healthdisparities/africanamerica...
1. Overuse of antibiotics in non-theraputic settings (e.g. agriculture)
2. Lack of interest in developing new classes of antibiotics
3. Insufficient interest in vaccine development
The last one is particularly interesting because a somewhat-effective vaccine[0] for Neisseria gonorrhoeae was discovered several years ago, but GlaxoSmithKline doesn't want to conduct the trials and submit it for approval until they find one that would be more effective and more profitable for them, so in the meantime it can only be used off-label, which means adoption is next to zero, because most physicians and patients don't even know it's an option. It's also only covered by insurance for its on-label use, which makes it difficult and expensive ($300 for the full series) even for people who want to get it.
Although GSK is at least ahead of Pfizer, who owns the patent for a nearly-identical vaccine that is also shown to be comparably effective against gonorrhea, and as far as I can tell has not even bothered to try using that as the basis for developing another.
[0] about 40%, which for comparison is higher than the effectiveness of the flu vaccine for every year in the past decade except one
Off-label use is using an approved drug for a different medical purpose than the one it was approved for.
I know how drug development works, but thank you.
The vaccine is approved for use against another bacterium in the same genus. It is not approved for use against gonorrhea. That means it can be used off-label.
No reason to get angry, nobody knows you from Adam. If you don't want to be treated like you're an idiot, post to a different website. The whole point of Hacker News comment sections is to see who can pretentiously promote their own alleged genius at the expense of everyone else
If I’ve learned anything over the past few years, the less effective the vaccine, the more profitable it is.
Are the inactivated virus vaccine more profitable than the mRNA vaccines?
mRNA vaccines were about 95% effective against symptomatic disease, but only against the targeted strain.
Speaks to priorities
In the USA, this can be done either through executive agencies, or by Congress. Is Congress unaware of the issue, or is there some political jockeying that prevents it? It seems like maybe it's worth redirecting funds from other basic research (medical or otherwise) into this area for at least a few years.
This problem disproportionately affects gay men and sex workers (of any gender/orientation), and the government's track record with public health issues that affect gay men is... pretty bad. The HIV epidemic began in 1981, and the first FDA-approved condom for anal sex didn't appear until 2022.
Heck, there wasn't even an FDA-approved gonorrhea test for gay men until 2019.
Or if you want something more recent, look at how badly the US government botched the Mpox epidemic. The US literally had Jynneos vaccines ready to go, and at multiple points either failed to arrange for the logistics of using them or (in more egregious displays) simply refused to administer them altogether.
The US government's mishandling of Mpox response has been so egregious that unless you were following it closely, you'd think sounds like satire or a conspiracy theory.
https://www.nytimes.com/2022/05/29/opinion/monkeypox-covid-a...
https://www.nytimes.com/2022/07/25/nyregion/nyc-monkeypox-va...
https://www.nytimes.com/2022/08/01/nyregion/monkeypox-vaccin...
1) Only about 0.2% of the US population contracts gonorrhea annually [0]
2) Many people see gonorrhea as a consequence of risky sex, which then butts up against religious beliefs and the like. The Religious Right would not generally be in favor of anything that makes sex less dangerous, and it would almost certainly become a culture war issue.
3) Until pretty recently, gonorrhea was not that big a deal because we had multiple antibiotics that worked against it. Public perception has not yet caught up with the science, thus there's not that many people clamoring for action.
[0] https://www.statista.com/statistics/626863/rate-of-cases-of-...
As a parent I find that idea abhorrent but it’s certainly not uncommon, which lead to demand for it not to be on vaccination lists and attempts to exclude it from medical coverage.
40% is terrible for something like gonorrhea, so unless it becomes much better you're better off being more diligent in your sexual escapades.
The flu vaccine is absolutely not a moneymaking enterprise (unless you define "money-making" as "spending less money on treating serious flu cases and sequelae", at which point you might as well leverage that same logic to argue against all preventive care).
> 40% is terrible for something like gonorrhea, so unless it becomes much better you're better off being more diligent in your sexual escapades.
This is a common attitude amongst the public, but it is completely at odds with how public health officials operate, because it's incredibly harmful and counterproductive.
Shaming people for sexual activity might feel good and "moral", but not only does it not actually reduce incidence, but it increases the rate of STI transmission.
40% is not perfect, and it's insufficient to merit mass public vaccination, but it's more than adequate for protecting high-risk groups.
That's an ABSURD statement. Your statement is completely at odds with how public health operates in most countries. I've worked in it both in the US and in Germany, and worked with two more countries' health systems. In Germany at a leadership level, that is actually very close to the layer that decides what gets covered by public health insurance. Most public health insurance only covers older treatments because the new treatments are too risky for them with too little data on successful treatments. Things such as shockwave treatment that performance athletes frequently use or mothers use for their thumb after breastfeeding are completely out of pocket, because not enough longterm studies show statistical significance on the treatment.
I understand that public health officials in the RECENT years(ten years is considered recent in public health or healthcare in general by the way) are trying to completely change the way public health works, because they want more direct control, but it is absolutely not YET how it works.
They’re also more expensive.
People can change behavior to avoid consequence. Shame is a response to violations of morality. They're really quite distinct.
Quite a lot of people are lately invested into the opposite, confusing those two, perhaps deliberately so.
For example, any suggestion that it may be unsafe to walk around totally drunk at night will be met with accusations of "blaming the victim", especially if the crime is rape, plus with (unhelpful) suggestions "you men need stop raping, I don't need to alter my behavior" - as if the perps were present in the discussion and inclined to take such suggestions.
Walking around totally drunk is unsafe for everybody, not least because all those self-inflicted injuries, but some people will deliberately try to silence such an idea.
...and you don't name the vaccine or provide any specific information about it.
I'm sure you see the irony!
What is this vaccine called, and for what other purpose has it been approved? Do you have a link to a study indicating that it is somewhat affective against Neisseria gonorrhoeae?
https://www.cidrap.umn.edu/studies-highlight-meningitis-vacc...
[1]: https://www.who.int/teams/immunization-vaccines-and-biologic...
The GlaxoSmithKline version is called Bexsero, but Pfizer has the patent on Trumenba, which is functionally the same thing. Both are used against bacterial meningitis serogroup B. Note that this is different from the standard meningitis vaccine required in most public schools and universities. Isomeone says they've been vaccinated against meningitis, they almost certainly are referring to the vaccine for serogroups A, C, Y, and W-135, which is different and not effective against gonorrhea.
There are tons of studies demonstrating the effectiveness of both against gonorrhea - it's almost a running joke that every 3-6 months a new one gets published, prompting a slew of articles expressing surprise and amazement, as if this hasn't happened so many times over the last decade that we've lost track. Pretty much all of them point to the range of 40% real-world effectiveness, which is actually quite good from a public health standpoint.
Knowing about it isn't really the main hurdle, though. Even if you know it exists, it's incredibly difficult logistically to get it, because your insurance company won't pay for it unless you've been provably in the vicinity of a MenB outbreak (which is rare in the US), and pharmacies will order it but generally not administer it, so even if you are fine paying for it yourself and manage to get your doctor to prescribe it to you, you'll end up in a weird logistical catch-22 where you can obtain it from a pharmacy but have to self-administer it (do not do this, unless you are trained) or find a not-so-kosher way to get it administered.
That's not surprising. New Zealand had a massive outbreak of MenB about ten years ago, resulting in a massive vaccination campaign, which is one of the reasons we actually found out about its effectiveness against gonorrhea in the first place.
It is true. I used to work in this field and have helped many people navigate this exact issue.
> There are 100's of drugs used off label dispensed from every pharmacy every day.
Vaccines are treated differently than drugs by insurance, often covered by completely different networks under the same brand. Most people don't know this, because there's no reason for them to encounter the difference, because the situation of having to obtain a vaccine that isn't part of the standard schedules from a pharmacy is very uncommon.
A doctor doesn't have the vaccine in their office, because it's not part of their standard schedule. Most won't order it for you (or even be able to), for the same reason.
They can send it to the pharmacy as a prescription, but the pharmacy (depending on both state law and pharmacy policy) often won't administer the vaccine to you, as it's not one of the "standard" ones that pharmacies do (e.g. flu, COVID-19).
If the pharmacy gives it to you, you can bring it to your doctor's office, but most providers won't administer any medicine that they didn't source themselves, because technically they have no way of verifying the provenance.
This isn't hypothetical - I used to work in this field, and I frequently help people navigate the logistics of obtaining this vaccine. It's really not simple, even if you're insured and willing to pay out-of-pocket and have a good relationship with a competent PCP.
Interesting. In Czechia, a doctor will send you to buy a vaccine against tick meningitis into a pharmacy and when you come back, will administer it.
It is up to you as an adult not to mess up.
That's the vaccine that GSK is developing as a candidate with the hopes that it will be superior (and also more lucrative) than Bexsero (the existing vaccine).
It's not inherently a bad thing that this might be an option, especially if it turns out to be effective, but keep in mind that GSK has been working on this for years, and that Bexsero's effectiveness has been widely known for years before that. So having a candidate that may be approved in 2026 or later is... not very reassuring given the threats of treatment resistance..
Are there different types of gonorrhea, or is it 40% effective against all strains? And how long does the effectiveness last?
The median age of female's first marriage was less than 22 for 100 years and rose to 28 in the last few decades[1]. I would assume this results in a higher number of partners and more opportunities for an STD to spread.
[1]: https://www.census.gov/content/dam/Census/library/visualizat...
That said I had initially assumed that the reason for using women specifically was probably that the male median age didn't increase in the same time-frame, but it looks like it's pretty much been in lockstep (https://www.census.gov/content/dam/Census/library/visualizat...) so it's an odd choice to not just mention the median age of marriage instead of women specifically.
Men are pigs (see that's a fact and an example of a moral judgement), and are almost exclusively to blame for the spread of STDs. Doesn't change the fact changing female sexual norms change sexual network connectivness and therefore how STDs spread
“The median age of female's first marriage was less than 22 for 100 years and rose to 28 in the last few decades”
and not
“The median age of male's first marriage was less than 26 for 100 years and rose to 30 in the last few decades”
or the neutral
“The median age of first marriage was more or less stable for 100 years and rose by about 6 years in the last few decades”
Judging others based on what we feel they really meant to say is a very dangerous course.
It actually is the more impactful number which was relevant to my original point (people are staying in the dating pool for a longer % of their life)
You may have had that point in your mind, but by choosing to only mention the numbers for women, the point you made was “women are staying in the dating pool for a longer % of their life”.
This is a common talking point among conservatives, but it's off-base. Not only has the median number of lifetime sexual partners not increased (in fact, it mostly flatlined from the 1960s, and even fell for many demographics after the 1980s), but it's irrelevant to the issue of gonorrhea, because single unmarried women in their 20s are not the main demographic affected by gonorrhea today.
https://www.washingtonpost.com/news/wonk/wp/2015/05/06/why-m...
I think it's a terrible trend and we should all start having sex with more people.
https://www.the-sun.com/lifestyle/4479617/average-number-sex...
I think most folks were actually being quite rational here. When the consequences of unprotected sex were so severe, most people used condoms. Right now, for someone on PrEP and/or the pill, the negative consequences of unprotected sex are primarily infections that can be cleared up with antibiotics or are generally not very serious.
A serious untreatable pathogen may well change people's behaviors again in the future.
Yes, new HIV infections have gone down since the 80s but have been relatively flat over the past decade or two, with the cumulative rate of infection continuing to rise. Of course IV drug use is another major source.
Neither condoms nor PrEP "become less effective with use". Either one is a way of acting responsibly for prevention.
We don't need to lay blame of STDs on the sexual revolution, we were already down bad as a species.
My non-scientific assumption is that there were less people who chose the lifestyle of "artists and writers". The sexual revolution took the lifestyle mainstream.
> 2. Lack of interest in developing new classes of antibiotics
> 3. Insufficient interest in vaccine development
you left out
4. Underuse of antibiotics in people so at risk they already have it, and then among those, them who will catch it again within the same social group.
We have subpopulations and particular communities who engage in "way more than their share" of risky sexual behavior, many of whom also use drugs and alcohol liberally, and in the worst cases (like say drug addiction/mental illness) don't generally seek medical care or otherwise take care of themselves.
I think the overuse of antibiotics on cattle has had much less to do with drug resistant human gonorrhea than giving populations humans who have gonorrhea insufficient quantities of inadequate antibiotics, particularly incomplete courses or treatment of cases without followthrough.That creates a perfect informal laboratory for developing strains of drug resistant bugs.
This is provably incorrect. The standard treatment protocol for gonorrhea is a single IM dose. There's no such thing as an "incomplete" treatment for gonorrhea.
> We have subpopulations and particular communities who engage in "way more than their share" of risky sexual behavior, many of whom also use drugs and alcohol liberally, and in the worst cases (like say drug addiction/mental illness) don't generally seek medical care or otherwise take care of themselves.
It's common and perhaps tempting to lump "people who have a lot of sex" together with "people who use drugs and alcohol" and "people who don't seek medical care or take care of themselves", but the data shows that that's not actually the case. Particularly for the subpopulations most affected by gonorrhea, where the data very clearly and unambiguously shows the opposite relationship.
People who tend to be sober and care about prophylactic care are the most afflicted with gonorrhoea?
Thx! this made me laugh, I mean really :)
>It's common and perhaps tempting to lump "people who have a lot of sex" together with "people who use drugs and alcohol" and "people who don't seek medical care or take care of themselves"
Has he ever been out clubbing in NYC or LA or SF bars and nightclubs on any weekend night? and many more nights of the week? do we think there is alcohol and drugs and resulting sex there? Has he ever engaged a series of prostitutes? Do drug addicts need money? Where do they get it, what's an easy unskilled job? Think there's a higher %age of gonorrhea on Tinder or among those dedicated to going out and partying? Are people who've been drinking more likely to have sex or not? Are there hookup apps that result in a much higher hit rate for unprotected sex than Tinder that people who go out and party use?
that is no longer true, the standard treatment protocol is multiple doses now, and it's the exact same treatment for chlamydia which is very common, and would lead to the same "spillover" development of resistant strains of both. And even if you have taken the prescribed dose whether it's one or multiple, if you are re-exposing yourself with varying half-lives of the antibiotics in your body, you are conducting experiments.
to most likely develop a resistant strain, you have to have the antibiotic and the infection strains in the same body, it's not random.
Incorrect. The standard treatment protocol for uncomplicated gonorrhea is a single IM ceftriaxone shot. The standard treatment protocol for chlamydia is a one-week oral doxycycline regimen. They are completely different treatments.
Treatment adherence is an potential issue for the chlamydia course, but not for gonorrhea, because it is administered as a single shot.
> and would lead to the same "spillover" development of resistant strains of both.
On the contrary, the treatment protocols were specifically constructed to avoid this.
> if you are re-exposing yourself with varying half-lives of the antibiotics in your body, you are conducting experiments.
That's technically true, but thankfully not particularly relevant, as most people aren't re-exposing themselves to gonorrhea within a few hours after being treated for it.
>That's technically true, but thankfully not particularly relevant, as most people aren't re-exposing themselves to gonorrhea within a few hours after being treated for it.
It doesn't matter what most people do, it only matters what the petri dishes for gain-of-function gonorrhea are doing. Resistant gonorrhea didn't appear quickly, and it didn't appear magically, it appeared after a sufficient number of people had both the pathogen and the antibiotic in their bodies, and the more times the better. We simply need to explain the behavior of those people.
Researchers have been tracking gonorrhea for decades, and they understand very well how resistance develops. Reinfections during treatment is not how. Nor is treatment adherence, because - as I pointed out - you were mistaken about the basic facts of the treatment protocol.
Regardless - between referring to people as "petri dishes" and your other ad hominem comment about me in this thread, it seems you're less interested in understanding the science here than you are in moralizing about other people's behavior. I share the attitude of most public health officials and sexual health professionals, which is that moralizing rhetoric is counterproductive, so I have no interest in engaging in that, and therefore there's no point in discussing further.
How is agricultural use of antibiotic fueling antibiotic-resistant gonorrhea? Are people having sex with animals, picking up STDs from them, and then passing them along to other people? Is there some other common repositiory of gonorrhea that both people and animals are coming into contact with to a degree that it's causing selection for antibiotic resistance?
Maybe we can finally get some funding for a proper vaccine.
I know last time I had to be treated for it (3ish years ago) I remember my doctor mentioning concerns about it and this being why they were attacking it both with a pill and a shot.
Even that is no longer the course of treatment for gonorrhea. Now it's a single shot (no pill). The protocol was updated in Dec 2020 due to... increased antibiotic resistance.
You're correct that we knew that this was coming. Unfortunately, much like many other societal problems, knowing about it doesn't actually translate into the necessary actions to address it.
But that was me interpreting (and remembering) what the doctor said so not really backing that by anything.
But thanks for letting me know about that. Not sure how I missed that news.
That's correct - the injection was paired with an oral macrolide as a sort of backup. However, macrolides were already not very effective against gonorrhea, and that's gotten worse. Meanwhile, the primary treatment for chlamydia used to be a macrolide, but now resistance is high enough that it's been dropped entirely from chlamydia treatment and replaced with a week-long course of doxycycline.
It's a tough balance, because overuse of antibiotics causes resistance, but so does ineffective treatment, and in this case there are two different bacteria that often present as coinfections, both of which are frequently asymptomatic, and both of which are impossible to distinguish from each other from symptomatic presentation (when symptomatic).
Existing prophylactic measures have proven to be a failure in practice. We wouldn't be in this situation if they were successful as a broad public health measure. Moralizing about how people should use condoms or abstain doesn't help; in fact, it's been proven time and again to be counterproductive.
Absent discovery of new antibiotic classes, an effective vaccine is the only way out.
There's no moralizing, just logic here.
> There's no moralizing
You can't use the phrase "irresponsible about prophylactics" in this context and claim you're not moralizing.
Irregardless, places like the CDC study what would be effective approaches. What makes you think a vaccine is an effective approach?
You're saying you suddenly and silently shifted the conversation to "legal responsibility" - something which nobody mentioned at all, including you - and didn't reference it?
Even if that were plausible (it's not), that would be a form of moralizing.
You've made many comments on this post, some of which pass overt and explicit judgements about contracting gonorrhea and condom usage (or lack thereof). There's no need to be coy in this one thread.
> Irregardless, places like the CDC study what would be effective approaches. What makes you think a vaccine is an effective approach?
What makes you think a vaccine would not be an effective approach, when "places like the CDC" (whom you yourself agree study this topic) uniformly take the opposite stance?
You can be legally liable for STD transmission. There are many cases that show that.
So you're using the technical definition of moralizing rather than the colloquial one. Fine. Seems like an odd point to make. How does this affect anything being said here regarding solutions? You seem to be moralizing that what I'm saying is wrong. Why are you allowed to do that then?
"which pass overt and explicit judgements"
Other than implying that the majority of cases are from not using protection, what judgements do you think I am exactly making? And more importantly, how do you think that affects what is being discussed around possible solutions to the problem?
"uniformly take the opposite stance?"
Please, do show me where they recommend a vaccine for gonorrhea.
I'm starting to feel like your just trolling. I've clearly laid out that the vast majority of people who are at risk for this disease are one who are irresponsible about prophylactics and would thus be irresponsible with a prophylactic vaccine. We could go farther into trade-offs on benefits vs adverse events. However, that information would be present in the CDC (or other org) documents recommending gonorrhea vaccines since treatments must be shown to be safe, effective, and providing net benefit. You can also see how the HPV vaccine has been a relative flop.
Edit: Why disagree?
Yes, there's also abstinence. However people aren't going to stop having sex, and they aren't going to use condoms frequently enough to control the disease.
Many poor countries have largely been spared the ravages of the AIDS epidemic because it is in fact possible for societies to reduce risky sexual behavior if they choose to do so.
Similarly, the only Asian country with high levels of unmarried births, the Philippines (what is it with former Spanish colonies) is contending with an AIDS epidemic: https://pulitzercenter.org/stories/philippines-hiv-cases-cou...
(almost) no one is using condoms for oral sex. The group of people who do are a rounding error.
I wonder what's smaller than a rounding, for what we would call the number of users of dental dams?
> Yes, there's also abstinence.
And you think those same people would get a vaccine and boosters, assuming an effective one could be made?
It fits into the vagina, allowing those with a vagina control of barrier-type contraception.
Unfortunately, the most reasonable genitalia to place a condom on is the penis, not inside the vagina. I’m not experienced with female condoms but I can’t imagine they would be more cost effective, comfortable, or feel better than a traditional male condom. Also due to scale there are plenty of opportunities for unique specializations in the male condom space (thinness, “Magnum” size, flavors, colors, ribbed textures, etc.) that will probably never happen with female condoms.
But the biggest reason for the rise of drug-resistant gonorrhea is that people don't like using condoms. It's very common for people to complain they can't maintain an erection while using a condom.Many of those people if they had tried female condoms would have not had any issues and much more safe sex would occur, decreasing gonorrhea infections.
"I’m not experienced with female condoms but I can’t imagine they would be more cost effective, comfortable, or feel better than a traditional male condom."
Well, for men with performance anxiety or ED, they can be much more comfortable and feel a lot better.
https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/g...
All this is rather pointless to point out, since the people with the issues are generally not following basic prophylactic guidelines (or even common sense in many cases). So in reality, the answer is "no", because we some people won't follow preventative programs.
I just don't think "we" are realistically going to convince a lot of people to start using plastic prophylactics in many cases. Of course, I sincerely and oh so genuinely urge you and everyone to.
Even during some of the heights of the AIDS epidemic, don't know anyone who used condoms for oral sex (though "don't get semen in your mouth" was actually very common, and that can significantly reduce transmission for both HIV and gonorrhea). TBH, can't think of a better application of "Who wants to chew gum with the wrapper on?". Would much rather limit sexual partners to serial monogamy than get full-body plastic every time I want to be intimate.
[0] Condoms made from sheepskin (really, sheep intestine) help prevent pregnancy but absolutely do not protect either party from STD transmission.
https://www.cidrap.umn.edu/studies-highlight-meningitis-vacc...
Agreed. Until then, people should maintain 6 feet distance between each other or wear some kind of mask around their private parts.
as surely as fire will burn
the gods of the copybook headings
w/terror & slaughter return