Antibiotic Resistance 101 — The Sad Case of Gonorrhea

Antibiotic Resistance

Calling all parents of young children! Have you ever dragged you sniffling little tot to the doctor’s office only to be told, and much to your chagrin, that your kiddo is sick with a virus and that the recommended treatment is to “take it easy for a few days” and to “drink plenty of fluids.” Seriously! You just paid doc all that money for him to tell you the same thing that your own mother told you back in the 1970s! “But doc, don’t you think he needs some amoxicillin!” — am I right!

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If this situation is familiar to you rest assured, because your child has a good doctor and I’m going to explain to you why I’m so comfortable saying that. You see, every physician knows that refusing to give little Johnny antibiotics for his sniffles is going to tick off mamma bear, but the reality is that using antibiotics for viral illnesses does absolutely no good and can potentially can cause a whole lot of harm. Firstly, our bodies are naturally teeming with bacteria both inside and out, and most of these bacteria are actually beneficial to us because they make things for our bodies that we need but that can’t make ourselves (like vitamin K, for instance), and because they deny growing space to pathogenic (disease causing) bacteria. Antibiotics don’t just kill bad pathogenic bacteria, they also kill good beneficial bacteria, and if you have a viral illness then the only bacteria that will be getting killed are the good guys because antibiotics don’t do squat to viruses. Even more importantly, the injudicious use of antibiotics turns our bodies into mass production factories for drug resistant strains of bacteria, and that’s what we’re going to discuss today.

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The reason that yogurt can help with GI dysfunction is because it contains good bacteria. Taking supplements that contain good bacteria while you are one antibiotics has been shown to decrease some of the side-effects of antibiotic therapy, including the potential for antibiotic-associated diarrhea. One particular type of antibiotic-associated diarrhea, C. diff, is a common cause of mortality (death) and morbidity (sickness) in hospitalized patients. 

Antibiotics have a longer history than most of us realize. The Chinese, the Egyptians, and the Romans all used naturally derived antibiotics, albeit without knowing what they were really doing and in a mostly haphazard fashion. Modern medicine truly began in the 1860s when Louis Pasteur, the French scientist extraordinaire who also invented the process of Pasteurization of milk, and Robert Koch realized that our world was teeming with microscopic organisms and that some of these tiny microbes could cause infectious diseases. This intellectual breakthrough is now referred to as “The Germ Theory of Disease” and it wasn’t long before other scientists realized that it might be possible to design microscopic “magic bullets” to kill disease-causing microbes without simultaneously killing the person that the microbes were making sick – this last caveat is important because you can technically cure any infection with a blow torch or a steamroller, the person just happens to die at the same time as the bacteria!

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Jumping into this vat of molten steel is 100% guaranteed to cure your cancer, AIDS, pneumonia…

The first successful “magic bullet” was salvarsan. Introduced in 1910 to cure syphilis, salvarsan was a major advance in the treatment of this epidemic sexually-transmitted infection that previously was treated with mercury (which is toxic as hell), hence the old adage “a night with Venus, a lifetime with Mercury.” Salvarsan was soon followed by the sulfa antibiotics, drugs which are still used today in the form of Bactrim to treat urinary tract infections and some skin infections. Sulfa drugs work fairly well against a specific type of bacteria called “Gram Positive Aerobes,” but they are largely ineffective against many other serious bacterial pathogens. Penicillin first became widely available in the early 1940s, the first true broad-spectrum antibiotic, and when Papa Penicillin was first introduced it would treat just about any bacterial infection that humans could manage to contract – what a deal! Unfortunately penicillin was overused and then some, and today there are far more bacteria that are impervious to penicillin than those that it will actually still kill off. The downfall of penicillin is nothing more or less than evolution at work.

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Tertiary syphillis. Syphillis is a three stage disease. The primary phase consists of a small genital sore that is painless. In the secondary stage the syphillis bacteria spread throughout the body — in the secondary stage it is actually possible to catch syphillis from someone by shaking their hand because the corkscrew-shaped syphillis bacteria can actually migrate through skin. In the tertiary phase (like in the picture), syphillis is a deforming disease that also destroys the heart and the brain. Al Capone is one (in)famous victim of tertiary syphillis.

A great way to understand how bacteria become resistant to antibiotics is to examine the notorious pathogen, Neisseria gonorrhoeae. Neisseria gonorrhoeae, aka: gonococcus, causes (big surprise!) gonorrhea, a sexually-transmitted infection that causes painful urination and purulent discharge (pus) from the male penis or from the female urinary tract. Untreated gonorrhea can lead to irreversible scaring of the urogenital tract, irreversible infertility, joint infections that have to be surgically drained, urinary retention, and a public reputation as the wrong kind of girl/guy to get involved with. The vernacular term for gonorrhea, “the clap,” derives from the habit of gonorrhea-infected men in the pre-antibiotic age clapping their pus-clogged penises between their hands to dislodge the mucus plugs so that they could urinate. Ouch!

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Gonorrhea — The Clap.

The first successful treatment for gonorrhea was sulfa drugs and the second was penicillin. Getting gonorrhea was no big deal as recently as the 1970s – a little penicillin and you were good to resume free lovin’ all over again. Then in the 1980s gonorrhea started becoming resistant to penicillin. You see, there are naturally small numbers of bacteria floating around in the environment that are resistant to just about any antibiotic that humans can possibly dream up. The use, particularly the overuse, of antibiotics killed off all the gonorrhea that wasn’t penicillin resistant. Before we knew it the only gonorrhea in circulation was totally resistant to penicillin – Darwinian natural selection at work, only guided in this instance by the ill-advised hand of human intervention.

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Free lovin’ at Woodstock.

Fortunately, a completely new type of antibiotic, ciprofloxacin (aka: Cipro) was invented at the same time that gonorrhea was becoming totally resistant to penicillin. And during the 1980s and 1990s all was well – if you contracted gonorrhea your doctor simply prescribed a short course of ciprofloxacin and you were back in the game again in time for lady’s night at the local watering hole. Except the problem is that gonorrhea is now nearly entirely resistant to ciprofloxacin for the same reason that penicillin doesn’t work for it anymore – all of the gonorrhea that was sensitive to ciprofloxacin is dead and gone and we’ve naturally selected for the few strains that were ciprofloxacin resistant. The former minority of gonorrhea is now the majority and today neither penicillin or ciprofloxacin will cure your puss-clogged penis (of course you could use a condom and avoid this issue entirely…).

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Moving on to the modern era, the current treatment for gonorrhea is a combination of an injection of the antibiotic ceftriaxone and an oral course of a second antibiotic called azithromycin, members of two classes of antibacterials that didn’t exist a few decades ago. Disturbingly, strains of gonorrhea that are resistant to ceftriaxone have surfaced in both Japan and in Britain and it probably won’t be long before the current standard treatment for gonorrhea is as worthless for treating this infection as penicillin or ciprofloxacin. Worse yet, there is no accepted alternative treatment for ceftriaxone-resistant gonorrhea.

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Gonoccocal arthritis. Say bye-bye to your knees.

The problem of antibiotic resistance is greatly exacerbated by three bad habits that our society is presently addicted to: 1) The Overuse of Antibiotics, 2) Antibiotic Noncompliance, and 3) The Agricultural Use of Antibiotics. The overuse of antibiotics for viral infections does no good because antibiotics don’t kill viruses. Most sinus infections and the majority of cases of acute bronchitis, two very common ailments, are caused by viruses. Using antibiotics in these cases does nothing but inflict harm because it selects for antibiotic resistant bacteria even though bacteria are not causing the majority of sinus infections or cases of acute bronchitis. Remember that the human body is naturally home to billions of bacteria and that most of are not harmful. Using antibiotics kills these good bacteria and selects for bacteria that are antibiotic resistant. Even if the surviving antibiotic-resistant bacteria don’t cause disease themselves, they can still “swap” DNA with other bacteria (the exact mechanisms are beyond the scope of this article), some of which do cause disease, and make those bad bacteria antibiotic resistant.

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Antibiotic noncompliance, namely starting a course of antibiotics but not finishing it, is also a major problem. Some bacteria are partially resistant to antibiotics, but would be killed if they were exposed to a full course of these drugs — not finishing all of a prescribed course gives these bacteria a chance to become fully resistant. Again, the exact mechanism is a little too complicated to discuss today. Finally, the ungodly-massive overuse of antibiotics by farmers to improve the yield of meat from their farm herds is selecting for antibiotic resistance on a gargantuan scale. As we’ve discussed before, most infectious human diseases originated in domestic animals and overusing antibiotics in these animals means that future epidemic diseases may well be totally resistant to our best drugs!

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All on antibiotics.

What can we do?

1) Not prescribe antibiotics for infections that are likely viral in nature. 

2) If you are prescribed a course of antibiotics, finish it!

3) Limit the use of antibiotics in farm animals to animals that are actually sick. Most agricultural use of antibiotics is prophylactic, e.g. used to prevent potential illness before the animals actually get sick, and to promote weight gain (for reasons that aren’t fully understood animals on antibiotics gain weight faster than those that aren’t).

Dr. Leonardo Noto

Physician and Author of Medical School 101, Intrusive Memory, The Life of a Colonial Fugitive, and The Cannabinoid Hypothesis. Amazon Link to Doc’s Writing:  http://www.amazon.com/Leonardo-Noto/e/B00ATVOMCW/ref=ntt_dp_epwbk_0

NOTE: The Life of a Colonial Fugitive — my dark historical thriller — is free for your e-reader at http://www.smashwords.com/books/view/215272 and on Amazon at http://www.amazon.com/Life-Colonial-Fugitive-Leonardo-Noto-ebook/dp/B006ZD0EYI/ref=tmm_kin_swatch_0?_encoding=UTF8&sr=&qid=    

Thanks for reading!

The Life of a Colonial Fugitive

Author Bio: Dr. Leonardo Noto is the nom de plume of a former airborne battalion surgeon who is now in civilian practice. Dr. Noto is the author of four books and he also writes for a medical education corporation that assists medical students, interns, and residents as they prepare for the medical board examinations. Dr. Noto is the proud father of an extremely spoiled 16-month-old American Bulldog who enjoys slobbering everywhere and tearing up things that he is not supposed to! Dr. Noto is an amateur practitioner of muay Thai and Brazilian jiu jitsu and he recently began learning to play the guitar (but he is currently a quite terrible musician, as his neighbors will readily attest).

Remember to discuss all health concerns with your personal physician (I don’t count!) before making any medical decisions. www.leonardonoto.com is intended to present general medical information for entertainment purposes and not as specific guide to any medical treatment. The author has made every effort to present accurate information; however, due to the ever-changing nature of medicine and the intrinsic caveats that are inherent in any particular case, no medical decisions should ever be made based on information gleaned from the internet (duh!). The internet and self-education are great, but they don’t replace your Doc!

The opinions voiced on this medical blog are solely the author’s own and they do not reflect the opinions or values of Dr. Noto’s employers, past or present. Dr. Noto’s medical blogs should never be used as supporting evidence for legal testimony — this is of course obvious to anyone who isn’t a complete moron, but some people are rather stupid.

 

 

 

References:

1.       Aminov, RI. A Brief History of the Antibiotic Era: Lessons Learned and Challenges for the Future. Front Microbiol. 2010; 1: 134.

2.       Julian Davies and Dorothy Davies. Origins and Evolution of Antibiotic Resistance. Microbiol. Mol. Biol. Rev. 2010, 74(3):417. DOI:10.1128/MMBR.00016-10.

3.       Germ Theory of Disease. http://www.sciencemuseum.org.uk/broughttolife/techniques/germtheory.aspx

4.       The History of Salvarsan. http://protomag.com/assets/paul-ehrlich-and-the-salvarsan-wars

5.       Sexually Transmitted Diseases. http://www.cdc.gov/StD/Gonorrhea/arg/default.htm

6.       Cephalosporin-Resistant Gonorrhea. http://www.medicinenet.com/script/mai/art.asp?articlekey=154633

7.        Amoxicillin Image: www.diefooddye.com

8.        Yogurt: www.flickr.com

9.        Molten Steel: www.commons.wikimedia.org

10.      Tertiary Syphillis: www.flickr.com

11.      Gonorrhea/The Clap: hardinmd.lib.uiowa.edu

12.       Hippies/FreeLove: www.commons.wikimedia.org

13.       Condom: www.commons.wikimedia.org

14.       Penicillin Ad: en.wikipedia.org

15.       Gonococcal Arthritis: hardinmd.lib.uiowa.edu

16.       Agricultural Antibiotics: en.wikipedia.org