Antibiotic treatment in the general population may play a role in how quickly gonorrhea develops resistance against treatment. This is demonstrated in a Norwegian study published in The Journal of Infectious Diseases.
Patricia Campbell, a PhD candidate at the Department of Clinical Medicine at UiO, is behind the study, and she found a clear connection between consumption of the most common types of antibiotics in Norway and resistance in gonococci, the bacteria that cause gonorrhea.
Campbell, who has a specialist background in medical microbiology, warns against resistance.
"Antibiotic resistance is one of the greatest threats facing humanity," she says.
To detect the threat earlier, Campbell has created a new method for identifying the development of antibiotic resistance at population level. She believes that the way we conduct surveillance today is part of the problem.
"We only discover the development of resistance after it has already become fact. My approach makes very early warnings possible. The method is also simple and accessible to countries with limited resources," she says.
Sharp increase in gonorrhea in Norway
Gonorrhea is a sexually transmitted infection that can infect the urethra, vagina, anus and throat. The infection often has no symptoms in the throat and vagina, so many people do not know that they are infected.
Gonococci cause the infection, and this bacterium has the ability to develop antibiotic resistance. Because of this, it is on the World Health Organization's list of priority pathogens. Except for during the corona pandemic, sharp increases in gonorrhea have been registered in Norway in recent years.
Norwegian antibiotic use forms resistance in bacteria that cause gonorrhea
Campbell's research found that increases in national antibiotic use were associated with higher levels of antibiotic resistance in gonococci.
"Even in a European context with relatively low consumption of antibiotics, Norwegian antibiotic use appears to form gonococcal resistance," she says.
Today, we only have one cure for gonorrhea: Antibiotics. If the gonococcal bacteria become resistant, the infection may become impossible to get rid of.
"Gonorrhea bacteria are what we call "fully competent." This means they are able to absorb genetic material directly from other bacteria," Campbell explains. She continues:
"They build a small tube between themselves and other bacterial cells and use this to send resistance genes to each other. This is especially important in the throat and rectum, where there are many bacteria for the gonococci to "play" with."
Untreated gonorrhea can lead to infections in the body
If gonorrhea goes untreated, it can have serious consequences. Not only because the infection is contagious, but because it can cause infertility and chronic pain. Untreated gonorrhea can lead to testicular infection in men and pelvic infection in women.
Babies born to infected mothers can develop serious eye infections, which can lead to blindness. In the past, gonorrhea contracted during birth was the most common cause of blindness in the Western world.
Campbell's findings underscore the importance of population-level antibiotic control, and the importance of monitoring resistance to maintain the effectiveness of existing treatment for infections.
Fungi and bacteria don't get along
It is partly thanks to the "miracle drug" antibiotics that doctors have been able to treat and cure serious infections in patients who otherwise would have had poor survival prospects.
If you get a bacterial infection in your body, you will often be given antibiotics, a medicine that destroys or inhibits the growth of bacteria. Antibiotics are substances produced by living organisms who possesses certain capabilities that keep other organisms away.
Both bacteria and fungi have the same food source-dead material. In order to have the whole food platter to themselves, they try to poison each other by excreting substances that the other does not tolerate.
Antibiotics can therefore be a very effective treatment for bacterial infections. Viruses, on the other hand, they have no effect on.
"Good" bacteria must fight for their lives with every antibiotic treatment
Why do bacteria that cause gonorrhea become resistant to antibiotics, even though antibiotics have not been used to treat such an infection in the body previously?
One proposed mechanism involves the human microbiome, meaning the collection of all microorganisms that live both on the inside and the outside of every person. These are absolutely necessary for our bodies to function properly.
When you treat an infection with antibiotics, most of the bacteria in your body are inhibited or killed, including the "good" bacteria.
This becomes a double-edged sword with antibiotic treatment: Not only do we lose the normal bacterial flora in the body, the resistant bacteria are also given the opportunity to multiply without having to compete with or be affected by the other bacteria.
"The microbiome bacteria are innocent bystanders, and they must fight for their lives with every antibiotic treatment. Only the most robust survive," Campbell says.
A domino effect that spreads
Campbell explains with an example:
"We also have a lot of chlamydia in Norway, and the treatment for this is typically one week with the antibiotic doxycycline. After treatment, the surviving "good" bacteria in the patient's microbiome will be more resistant to doxycycline. If the patient later gets gonorrhea, these genes can be transferred directly to the gonorrhea bacteria from the microbiome."
In the worst case, bacteria can become multi-resistant, meaning that they become resistant to many types of antibiotics.
"Gonorrhea is much more difficult to treat in countries like Thailand, because you can buy antibiotics in convenience stores. This is actually a big threat to us here in Norway. Among men who buy sex abroad, it is heterosexual men who bring antibiotic-resistant gonorrhea home."
Reason to fear a lack of treatment for gonorrhea in the future
If gonorrhea in a person has become resistant to all types of antibiotics, the infection becomes impossible to treat and cure.
"Gonorrhea always finds a way around any antibiotic we use," Campbell says, and continues:
"Resistance to one type of antibiotic can create resistance to other types of antibiotics. Researchers have identified a mechanism that links resistance to the antibiotic ciprofloxacin to resistance to two new antibiotics that will soon be on the market."
In Norway, there is a high incidence of resistance to ciprofloxacin.
"So, unfortunately, I really don't expect any of these new antibiotics to last long, unless we are extremely careful with them," Campbell says.
Don't take antibiotics unless you must
Campbell's new method could enable health authorities to react before resistance becomes widespread.
"My method picks up the very first signs that a bacterial population is heading towards resistance. I hope others can test my method with other types of bacteria," she says.
She hopes her research changes the way we do surveillance.
"Antibiotic resistance will kill an enormous number of people in 50 years. I want to help prevent that," she says.
"Don't take antibiotics unless you absolutely have to. Everything is connected."
