Drug-Resistant Gonorrhea: How We Lost Track

if I were starting this blog today, I’d be tempted to name it the Department of Unintended Consequences. So much of what I write about seems to belong in that zone: Send U.N. troops to Haiti, start a cholera epidemic. Aim to eradicate wild polio, clear the way for the vaccine-derived kind. Drive down the price of producing animal protein, ramp up antibiotic resistance.

Now add to the list: Develop cheap rapid tests for detecting sexually transmitted diseases, and lose the ability to track that those diseases are becoming resistant to the last antibiotics that work reliably against them.

 In my latest column at Scientific American, I take a look at the recent rapid increase in antibiotic resistance in gonorrhea. I’ve explored this problem in two earlier posts here: Resistance to cephalosporins, the last class of antibiotics that are reliable, cheap, and effective enough to not require a follow-up visit, first emerged in Japan in 1999 and began spreading around the globe from there, arriving in California in 2008 and moving across to the East Coast by last year.

That’s bad enough, because while we may think of gonorrhea as a minor illness long ago eclipsed in seriousness by HIV/AIDS, it remains one of the most-reported diseases in the country, with more than 600,000 known cases per year. Gonorrhea that goes untreated is personally and socially costly, causing pelvic inflammatory disease, infertility and widespread organ damage. And when resistance is not detected, it is possible for gonorrhea to go, effectively, untreated, because the drugs that are given to cure the infection will not work against the resistant form.