There's nothing super about 'super gonorrhoea'

April 4, 2018 3:30 AM

Another victory for the bugs in today's antibiotics arms race Few people today have experience of life just a century ago where infections we now regard as mundane would often be fatal or seriously debilitating. And the jury is still out as to whether we can avoid going back there. If we get this wrong the impact on health and burden of disease is hard to imagine. Having to live with untreatable chronic gonorrhea could make life thoroughly miserable. Even worse, perhaps, is the spectre of treatment resistant syphilis - with its effects on both the body and the mind. Before antibiotics rendered it treatable tertiary syphilis was responsible for a large proportion of long-term psychiatric hospitalizations.
posted by Neil Hunt (26 comments total)

OK, kids, you've had your fun, but seriously...
posted by Halloween Jack at 4:29 AM on April 4, 2018 [3 favorites]

I’m old enough to remember seeing very old, usually male victims Of tertiary syphallis trying to get around. They were a terrible sight. Yes the psychiatric hospitals were full of such people. They could not care for themselves. On release they had to live in boarding homes. In my day very few women survived with tertiary syphallis. Males however were on release from psychiatric facilities not a rare sight begging. They lived in missions or on the streets and were if ‘healthy’ enough, vectors for further infections. The reason infected women died was that the relative lack of symptoms meant they did not receive treatment in time. Often they were in worse shape and died sooner.
Antibiotics and better testing helped. Now we’re back at Square One. :(
posted by Katjusa Roquette at 4:37 AM on April 4, 2018 [16 favorites]

Syphilis, HIV and a relatively new sexually transmitted disease – Mycoplasma genitalium – are also developing resistance to antimicrobial treatments.

[...]

Resistance to antibiotics is a problem in other sexually transmitted diseases but are not at the same level seen in gonorrhoea. Resistance to HIV drugs, particularly in parts of the developing world, is becoming a concern but there are still alternative treatments.

HIV is a retrovirus, not a bacterium, and this piece is blurring the distinction. Resistance to antiretroviral agents used to treat HIV is problem, but it's a different thing.

And when it comes to misuse of antibiotics, it's important that people have an understanding of what they're for and what they're not. Like the person in my office who was loudly complaining the other week that her doctor wouldn't give her antibiotics for her cold. Some people are dangerously ignorant and sloppy reporting like this doesn't help.
posted by mandolin conspiracy at 5:57 AM on April 4, 2018 [19 favorites]

The case of Eugene N, singer of the marseillaise, is interesting to me also in the sense of what it leaves out. No mention is made of any kind of medical assistance offered or provided to his wife, who, having noticed the symptoms a full decade ago, could surely have been exposed and infected as well, no? I don't attribute this absence to the authors of the current article but to the original doctors in 1901, but it still seems like it should be worth a footnote.

oh or were they not sure how infection was transmitted still? hmm.
posted by poffin boffin at 6:02 AM on April 4, 2018

oh or were they not sure how infection was transmitted still? hmm.

No, they knew. I was a researcher on 18th-century medical history back lo these many years ago, and my but there were a lot of cases of Lord and Lady B_____ being treated with mercury for syphilis, because Lord B____ had been having rather a wild time on his last business trip to London har har. (Also a lot of cases of babies born with congenital syphilis which is just heartbreakingly horrible.)

It was even known among the Lord B____s of this world that condoms could prevent syphilis being transmitted, although 18th century condoms were let us just say probably not a technology you'd want to trust with your life.
posted by Catseye at 6:40 AM on April 4, 2018 [10 favorites]

Syphilis, HIV and a relatively new sexually transmitted disease – Mycoplasma genitalium – are also developing resistance to antimicrobial treatments.

Not only is HIV not bacterial, the resistance patterns of HIV are well known and one can take drugs in another class if you are infected with a class-resistant strain. Yes, this is something to be aware of, but it is not on the same level as antibiotic resistant bacteria.

Also, if you do not take your entire course of antibiotics for any reason, I would like to have a little sit down chat with you.
posted by Sophie1 at 6:47 AM on April 4, 2018 [5 favorites]

Does anybody know how worried we should be about the superbug crisis? Like, are we just moving towards a world where antibiotics are ineffective for a broad spectrum of infections and going to the hospital is basically entering a MRSA infection zone, and will common infections just be untreatable in 15 years? Or is there a new class of drugs in development that will save us all if we could just throw some more R&D behind it?
posted by dis_integration at 7:02 AM on April 4, 2018 [1 favorite]

Or is there a new class of drugs in development that will save us all if we could just throw some more R&D behind it?

"Every currently available antibiotic is a derivative of a class discovered between the early 1900s and 1984." Pew Charitable Trusts, "A Scientific Roadmap for Antibiotic Discovery" (2016) [pdf]. In that article, Pew lays out a 5 year plan for improving antibiotic discovery. Note that the immediate goal is infrastructure and funding for discovery, not that they expect new drugs to be discovered within 5 years, much less brought to market.

There are also a large number of alternatives to traditional antibiotics that are being worked on (e.g. vaccines, probiotics, phage-derived therapies, antibodies, and antimicrobial peptides), but many of those would only be effective against one particular species of bacteria.

As far as I know the only novel antibiotic past Phase I trials is ridinilazole, which is only for C. difficile. It may be commercially available by 2021 if Phase III goes well.
posted by jedicus at 7:42 AM on April 4, 2018 [5 favorites]

Sophie1: Not only is HIV not bacterial, the resistance patterns of HIV are well known and one can take drugs in another class if you are infected with a class-resistant strain. Yes, this is something to be aware of, but it is not on the same level as antibiotic resistant bacteria.

mandolin conspiracy: HIV is a retrovirus, not a bacterium, and this piece is blurring the distinction. Resistance to antiretroviral agents used to treat HIV is problem, but it's a different thing.

I'm not sure what exactly you guys are objecting to here, the article doesn't imply that HIV are bacteria.

Antibiotics are compounds that can be used to treat bacterial disease by taking advantage of differences between bacteria and us, inhibiting processes that happen in bacterial cells but not human cells. They do things like take advantage of the fact that bacterial ribosomes are pretty different from ours and work by acting as a monkey wrench that sabotages theirs but doesn't fit into ours. There are also some other important antibiotics that target things like differences in DNA synthesis, membrane synthesis, central metabolism, and a few others. They are essentially a selective toxin, but unfortunately there is a depressingly short list of differences between us and the bacteria that ail us to attack. Resistance to antibiotics happens when bacteria do something like change the molecular shape of the thing the antibiotic attacks so that it still works but is no longer vulnerable, or re-purpose some system to do things like very efficiently pump the antibiotic out of the cell. Any bacterial cell that acquires this kind of gain of function, either through mutation or through horizontal gene transfer from another bacteria, will have an immense advantage over the non-resistant wild type in the presence of antibiotics and will spread as if the antibiotic pressure weren't there. Just because a bacterial strain gains resistance to β-lactam antibiotics that inhibit membrane synthesis without inhibiting cell growth, making them explode, doesn't mean it would also gain resistance to protein synthesis inhibitors like Clindamycin.

More or less the exact same thing happens with HIV and antiretrovirals. There is a perspective on viral life that is gaining traction in the Viruses of Microbes community that I think would be helpful here, where we increasingly think of the virus as being the virally infected cell that is propagated by viral particles rather than as a particle propagated by virally infected cells. Especially thought of in this way, the antiretrovirals that are used to treat HIV are very much like antibiotics in that they are compounds that are more toxic to HIV-infected cells than they are to non-infected cells. Indeed at least most work by targeting aspects of viral metabolism that are different than human metabolism, like using nucleoside analogues (as well as other things that aren't nucleoside analogues) that interfere with HIV polymerases but not human ones or things that inhibit enzymes that HIV needs but human cells don't have like integrases and specific kinds of proteases. Where the analogy breaks down a little is in entry inhibitors that keep HIV from getting into healthy cells, but even there the evolutionary pressure selecting for resistance is more or less the same.

You might be thinking of how HIV is specifically weird even among viruses for how absurdly fast it evolves, allowing different classes of antiretrovirals to often be cycled through and re-used after some time in a way that doesn't really work with at least most bacteria for how persistent antibiotic resistance typically is even in the absence of antibiotic pressure, but its more or less the same basic concept.
posted by Blasdelb at 8:20 AM on April 4, 2018 [19 favorites]

Well, this has provided me with lots of interesting reading and loads of nightmare fuel. Also, it's made me wonder why Syphilis hasn't been included much in historical fiction? If syphilis has been killing people in such dramatic fashion since the 1500s, why haven't I read about it more in novels?
posted by pjsky at 9:22 AM on April 4, 2018 [1 favorite]

If syphilis has been killing people in such dramatic fashion since the 1500s, why haven't I read about it more in novels?

Honestly? because it's premium grade nightmare fuel. I'm sure there are a few books that dig into it, but I'm sure more than a few authors set out to do research
see the old photos...
and decide to give the protagonist TB instead.
posted by Homo neanderthalensis at 9:31 AM on April 4, 2018 [9 favorites]

Blasdelb: I'm not sure what exactly you guys are objecting to here, the article doesn't imply that HIV are bacteria.

The way it read to me, I felt like the way it was framed kinda muddies the waters - which I feel like is a problem from my layperson's perspective, given how confused people can be about what antibiotics are for and what they're not for - thinking specifically about how people march into a doctor's office demanding antibiotics for something viral, which is a thing that happens.

More of a call for more precise language around it, I guess?

There is a perspective on viral life that is gaining traction in the Viruses of Microbes community that I think would be helpful here, where we increasingly think of the virus as being the virally infected cell that is propagated by viral particles rather than as a particle propagated by virally infected cells. Especially thought of in this way, the antiretrovirals that are used to treat HIV are very much like antibiotics in that they are compounds that are more toxic to HIV-infected cells than they are to non-infected cells. Indeed at least most work by targeting aspects of viral metabolism that are different than human metabolism, like using nucleoside analogues (as well as other things that aren't nucleoside analogues) that interfere with HIV polymerases but not human ones or things that inhibit enzymes that HIV needs but human cells don't have like integrases and specific kinds of proteases. Where the analogy breaks down a little is in entry inhibitors that keep HIV from getting into healthy cells, but even there the evolutionary pressure selecting for resistance is more or less the same.

Ok. Stuff like this is why I come here. Super interesting. Thanks for this!
posted by mandolin conspiracy at 9:47 AM on April 4, 2018

If syphilis has been killing people in such dramatic fashion since the 1500s, why haven't I read about it more in novels?

Al Capone became a severely impaired simpleton as result of syphilis. In any book or movie about him it is just a footnote because other than the simple fact of it what would be interesting about it? I suppose you could go with some Lenny in Of Mice and Men with it but even Lenny got to have hope and plans. Death by syphilis offered none of that.
posted by srboisvert at 10:01 AM on April 4, 2018 [1 favorite]

Also, if you do not take your entire course of antibiotics for any reason, I would like to have a little sit down chat with you.

What, even the reason of "the doctor told you to stop"?
posted by inconstant at 10:15 AM on April 4, 2018 [1 favorite]

why haven't I read about it more in novels?
It shows up now and again. The male protagonist of Neal Stephenson's Baroque Cycle has it. IIRC, he is known as Half-Cocked Jack Shaftoe for reasons related to his method of treatment.
posted by rhamphorhynchus at 10:37 AM on April 4, 2018 [1 favorite]

In the US, antibiotics have been over-prescribed, but in some countries they are quite easy to get and with little education. But there's massive overuse of antibiotics in meat agriculture, and I suspect that's a big part of the problem. The rise of antibiotic-resistant diseases is just one of the coming Apocalypses.
posted by theora55 at 10:39 AM on April 4, 2018 [12 favorites]

If syphilis has been killing people in such dramatic fashion since the 1500s, why haven't I read about it more in novels?

Isn't one option that you have been and didn't know it? That the 1843 novel you're reading was using language that, to current readers, said THIS CHARACTER HAS THE SYPHILIS or SHE IS KNOCKED UP AND WENT AWAY TO HAVE HER SINBABY OR JUST DIE IN CHILDBED in no uncertain terms but that you don't recognize those words as meaning that?
posted by GCU Sweet and Full of Grace at 11:07 AM on April 4, 2018 [8 favorites]

THIS CHARACTER HAS THE SYPHILIS

That's usually "dissipated," right?
posted by asperity at 11:27 AM on April 4, 2018 [2 favorites]

Isn't one option that you have been and didn't know it?

“The sins of the father.”
posted by delight at 11:27 AM on April 4, 2018

If syphilis has been killing people in such dramatic fashion since the 1500s, why haven't I read about it more in novels?

GCU is right. It was coded in Victorian fiction. Madness in the family, dissipated old rakes, young brides dying, blind and sickly children . . .
posted by Countess Elena at 12:35 PM on April 4, 2018 [6 favorites]

"He lived dissolutely, and died in a like manner."

"He passed of the French disease in a charity hospital."

"Old Jebediah Rottencock sure lived up to his name, eh?"
posted by Halloween Jack at 2:25 PM on April 4, 2018 [6 favorites]

But there's massive overuse of antibiotics in meat agriculture, and I suspect that's a big part of the problem.

This is the elephant in the room, people don't appreciate the vast quantities of antibiotics being pumped into livestock, and how problematic it is.

Over 70%of our antibiotics go straight into livestock, if you included aquaculture that figure would be even higher.
posted by smoke at 2:43 PM on April 4, 2018 [11 favorites]

On second thought, maybe leaving the basement's not such a great idea.
posted by bookman117 at 5:15 PM on April 4, 2018 [2 favorites]

I read the novel The Big Sky at probably too early of an age, but the description of when the main character catches the clap, and what the treatments were, made a vivid impression on my young mind.

And, as has been noted above, once you first see the coded references in older books, you can't stop seeing them. They mostly left out the graphic parts, but the horror comes through pretty clearly.
posted by Dip Flash at 8:45 PM on April 4, 2018 [1 favorite]

Genealogy is a great way to be surprised by the things that used to kill people before the advent of modern medicine (my tree features lots of tuberculosis, and things like 'Exhaustion of Mania with Epilepsy'. I have two male ancestors who died from General Paralysis of Insane, which is described in the second link - which I'm going to read with great interest because there really isn't a lot of accessible information about GPI out there.

Sadly I've never found case notes from any of my ancestors who died in asylums - and there were a few - but there are whole case books from other regions digitised on Ancestry, and they're fascinating.
posted by andraste at 10:53 PM on April 4, 2018

I realize I'm slightly derailing my own thread but in light of the viral discussion people who have access may appreciate this iPlayer/BBC animation. I've looked at a few of these things and this stood out from the crowd
posted by Neil Hunt at 8:26 AM on April 9, 2018