[HN Gopher] Drug-resistant cases of gonorrhea detected in the US
___________________________________________________________________
Drug-resistant cases of gonorrhea detected in the US
Author : Tomte
Score : 110 points
Date : 2023-01-20 18:14 UTC (4 hours ago)
(HTM) web link (arstechnica.com)
(TXT) w3m dump (arstechnica.com)
| this_steve_j wrote:
| The Massachusetts Department of Health alert also reinforces the
| CDC's recommendation to use high doses of the antibiotic
| ceftriaxone for the treatment of all gonorrhea cases and to
| perform follow-up tests to ensure all patients with gonorrhea are
| successfully treated.
|
| 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...
| decremental wrote:
| [flagged]
| adrianN wrote:
| Our ancestors' junk did fall off regularly. I'm not sure
| whether their methods were perfect.
| tgv wrote:
| They did have a much smaller partner pool, though, which is a
| prevention measure. But just use condoms.
| capitol_ wrote:
| How sure are we really about that?
|
| There is an large amount of history backwards in time, and
| not a large amount of reliable documentation regarding the
| amount of partners people had.
| mouse_ wrote:
| What exactly is it you think our ancestors were doing to
| successfully avoid disease?
| decremental wrote:
| Not be on Tinder.
| AlotOfReading wrote:
| Gonorrhea was named by a Roman physician called Galen some
| 1800 years ago. I'm fairly certain his patients weren't
| using Tinder.
| SoftTalker wrote:
| Well, they developed an elaborate system of morals that
| stigmatizes promiscuity. Whether it was "successful" is
| debatable, given that the diseases all still exist, but no
| denying it works at the individual level, if practiced
| unfailingly.
| glhaynes wrote:
| This the same knowledge that told us we should stone a man to
| death if he lies with another man?
| Fomite wrote:
| _laughs in syphilis_
|
| STIs were _rampant_ in the past. It 's not Ole Tyme Morals that
| keep them at bay - it's antibiotics.
| nerdjon wrote:
| Sigh... we knew this was coming for a while. Thankfully they were
| still able to treat it but it is very concerning.
|
| Maybe we can finally get some funding for a proper vaccine.
| giantg2 wrote:
| I'm not exactly sure why you're getting downvoted. While I
| agree that we knew this was coming (Europe has similar
| emergence), I don't think a vaccine is really the best option
| here (although you could expand on that point. We already have
| proven prophylactic measures to prevent this disease.
| crystaln wrote:
| > We already have proven prophylactic measures to prevent
| this disease.
|
| 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.
| yucky wrote:
| > Yes, there's also abstinence.
|
| I assume they meant monogamy. Or for those who can't go
| with just one sexual partner, condoms are a thing.
| mrguyorama wrote:
| Especially when most people currently view gonorrhea as
| "not a big deal, go to the doctor and get a shot". People
| will be caught off guard by this development.
| pcthrowaway wrote:
| Isn't Gonorrhea also transmissible from oral sex?
|
| (almost) no one is using condoms for oral sex. The group of
| people who do are a rounding error.
| rayiner wrote:
| That's a remarkable assertion, given that there's plenty of
| countries where strong taboos on having multiple sexual
| partners has effectively controlled diseases such as AIDs.
| For example, AIDS prevalence in Egypt and Pakistan (which
| have relatively well developed healthcare systems with
| accurate statistics, and are also the target of extensive
| western healthcare aid and associated scrutiny) is just
| 0.1%. In the United States it's 0.36% and in many countries
| it's well over 1%.
|
| 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.
| JamesBarney wrote:
| While it's possible in theory to undo the sexual
| revolution in the US, it's also would be practically
| impossible.
| crystaln wrote:
| It would also be a huge regression for humanity IMO.
| rayiner wrote:
| That's probably true. I'm just pointing out that "we
| can't" is a different argument than "we like it this way
| and are willing to put up with the consequences."
| mensetmanusman wrote:
| It's happening slowly already due to which world views
| are repopulating and which are doing the opposite...
| jelliclesfarm wrote:
| That's like saying ppl aren't going to stop cutting
| themselves just because they bleed when they do.
| nerdjon wrote:
| Maybe the "We knew this was coming" thing?
|
| 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.
| chimeracoder wrote:
| > 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.
| nerdjon wrote:
| I did not know that the treatment plan changed. I guess
| it makes sense, it sounded like at the time the pill was
| almost a "just in case" but it really was the shot.
|
| 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.
| chimeracoder wrote:
| > I did not know that the treatment plan changed. I guess
| it makes sense, it sounded like at the time the pill was
| almost a "just in case" but it really was the shot.
|
| 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).
| chimeracoder wrote:
| > I don't think a vaccine is really the best option here
| (although you could expand on that point. We already have
| proven prophylactic measures to prevent this disease.
|
| 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.
| stjohnswarts wrote:
| I'm not sure why you're being downvoted, nothing in your
| statement is incorrect.
| red-iron-pine wrote:
| If HN is anything like reddit there are 1) bots going through
| to downvote things, 2) aggressive actors who downvote every
| one of your posts because you told them their idea was dumb
| in an unrelated thread, and -- most likely -- is that the
| site "fuzzies" your score after you post to obfuscate actual
| upvotes and make the first 2 points harder.
| jMyles wrote:
| Anti-microbial stewardship is, by far - very far, the most
| important imperative in medicine (including animal husbandry)
| right now.
|
| 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.
| chimeracoder wrote:
| > A safe and effective vaccine, while welcome and important,
| only kicks this can down the road - and not very far.
|
| 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".
| aidenn0 wrote:
| Seeing how many parents refuse the HPV vaccine for their
| children, I don't see any STD vaccine getting enough uptake
| (at least in the US) for containment, let alone elimination.
| chimeracoder wrote:
| > Seeing how many parents refuse the HPV vaccine for their
| children, I don't see any STD vaccine getting enough uptake
| (at least in the US) for containment, let alone
| elimination.
|
| 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.
| jMyles wrote:
| Oh yes, I agree.
|
| 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.
| red-iron-pine wrote:
| > 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.
|
| 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.
| jMyles wrote:
| > How does it do so? Vaccines appeared to be effective at
| eradicating polio and smallpox
|
| 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.
| javajosh wrote:
| Gonorrhea is entirely stoppable - convince people to hate each
| other (especially men v women), they'll stop fucking, and all STD
| transmission will stop. As a happy side-effect, this will solve
| climate change, too, eventually.
|
| EDIT: annoying to be downvoted, especially since I am technically
| correct, the best kind of correct.
| yjftsjthsd-h wrote:
| You're not "technically correct", because people can hate each
| other and still have sex, so your thesis doesn't actually hold.
| [deleted]
| onlyrealcuzzo wrote:
| But what if I like having sex?
| dismalpedigree wrote:
| Sinner!
| coolspot wrote:
| Take this matter in your own hands.
| adrianN wrote:
| Extinction by lack of procreation won't stop climate change at
| this point. It's too slow. It will just solve "the problem" by
| not having anybody around who could care.
| throw_pm23 wrote:
| I'm pretty sure things would reach a stable equilibrium in
| one generation without human activity. But I guess we'll
| never know either way.
| adrianN wrote:
| We already emitted enough carbon that the scenarios that
| permit us to mostly ignore warming all require massive
| atmospheric capture, aka negative emissions.
| inglor_cz wrote:
| Never had a sincere hate fuck? You missed out on something,
| sir.
| goodSteveramos wrote:
| Getting people already very unlikely to contract STDs to take
| absurd precautions will have virtually no effect. Populations
| with high rates of STDs need to be studied to find strategies
| specific to them that will be effective in changing behaviors in
| these populations that result in the high STD prevalence.
|
| https://www.cdc.gov/nchhstp/healthdisparities/africanamerica...
| rngname22 wrote:
| Female condoms need to be more widely distributed and advertised.
| It's absurd that you can't buy them at a grocery store, pharmacy,
| etc.
| red-iron-pine wrote:
| Forgive any ignorance, but what is the difference from the male
| version?
| ThePowerOfFuet wrote:
| > Forgive any ignorance, but what is the difference from the
| male version?
|
| It fits into the vagina, allowing those with a vagina control
| of barrier-type contraception.
| lockhouse wrote:
| Is there any demand for them? I'm assuming they're not being
| widely distributed and sold because there isn't enough people
| interested in buying them.
|
| 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.
| vinni2 wrote:
| They should invent a vaccine for it. I also read meningitis
| vaccine is somewhat effective against gonorrhea.
| raylad wrote:
| This vaccine, the four-component serogroup B meningococcal
| (4CMenB) vaccine, is 40% effective at preventing gonorrhea
| infection.
|
| https://www.cidrap.umn.edu/studies-highlight-meningitis-vacc...
| chimeracoder wrote:
| This has been a known problem for years. There are three issues
| at play:
|
| 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
| devmunchies wrote:
| Those are scientific issues, but STD spread is also a by-
| product of social changes.
|
| 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...
| frontman1988 wrote:
| Another social change is increase in oral sex. Most people
| don't use protection while doing oral sex which is also the
| cause of widespread STDs. Eating ass is a good way to get a
| bunch of disease causing microbes into your body. I don't
| know why it's normalized these days, it wasn't the case in
| the past.
| yardie wrote:
| Everything I've read about the 19th and early 20th century
| has lead me to believe that practically everyone was a
| walking petri dish. Spreading STDs weren't well understood.
| Lot's of supposedly brilliant artists and writers usually met
| there end by going raving mad, usually from syphilis. But
| were just famous enough to have it documented by their
| friends.
|
| We don't need to lay blame of STDs on the sexual revolution,
| we were already down bad as a species.
| chimeracoder wrote:
| > 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.
|
| 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.
| kar5pt wrote:
| This would be a great comment if you cited sources.
| giantg2 wrote:
| Do you have some links? The surveys I found show the
| opposite for number of partners. I'm also curious about the
| demographics.
| standardUser wrote:
| This article is a little dated but it shows the data very
| clearly. Subsequent surveys have shown similar results,
| with Boomers and X out-sexing Millennials (by # of
| partners) and with some signs indicating Z is on track
| for even fewer partners...
|
| https://www.washingtonpost.com/news/wonk/wp/2015/05/06/wh
| y-m...
|
| I think it's a terrible trend and we should all start
| having sex with more people.
| giantg2 wrote:
| Pay walled, so I can't see your article. This article
| references a survey with a fairly small sample size. I
| found one other article that _claimed_ what you are, but
| they were stupidly comparing millennials ' lifetime
| average of 8 to boomers lifetime average of 10, even
| though boomers have been around almost twice as long
| (millennials would likely track to surpass boomers at the
| same age). That's why I was curious for more (open) data.
|
| https://www.the-sun.com/lifestyle/4479617/average-number-
| sex...
| giantg2 wrote:
| Condom use has also declined over the past decade or so.
| hn_throwaway_99 wrote:
| This is primarily due to HIV (rightfully) no longer being
| seen as a death sentence, and PrEP being widely available.
|
| 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.
| giantg2 wrote:
| It's kind of sad to think that people would rather help
| create the next catastrophe by relying on treatments that
| are known to become less effective with use than act
| responsibly for prevention.
|
| 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.
| chimeracoder wrote:
| > It's kind of sad to think that people would rather help
| create the next catastrophe by relying on treatments that
| are known to become less effective with use than act
| responsibly for prevention.
|
| Neither condoms nor PrEP "become less effective with
| use". Either one _is_ a way of acting responsibly for
| prevention.
| zwkrt wrote:
| Why is this women's fault somehow?
| sbaiddn wrote:
| How do you infer that op is blaming women? They merely
| stated a fact and didn't assign any blame.
| Avshalom wrote:
| >" median age of female's first marriage "
| Volundr wrote:
| The mere mention of a statistic involving a gender does
| not blame that gender. The point of noting the increase
| in marriage age is to point out that presumably the
| number of sexual partners increase as well, which can
| lead to more spread. Presumably women having more sexual
| partners ALSO means men having more, it takes two to
| tango and all that.
|
| 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.
| acdha wrote:
| I think that phrasing can reasonably be interpreted as
| critical: it sounds like it's saying it's somehow women's
| responsibility and that dovetails with the very common
| cultural trope of assuming that men are irresponsible
| horndogs who can't be expected to control ourselves. I
| don't know if OP comes from that background but it's
| common, especially in strongly religious communities
| where you have the "Eve tempted Adam into sin" mythos.
| sbaiddn wrote:
| That's a statement of fact that is either true or not. It
| is not a statement of culpability in anyway.
|
| 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
| Someone wrote:
| I think the OP indirectly does that. They chose to say
|
| _"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"_
| sbaiddn wrote:
| How about we judge people for what they say and not what
| we fantasize they meant to say?
|
| Judging others based on what we feel they really meant to
| say is a very dangerous course.
| acdha wrote:
| They're being judged by what they actually said. They
| could have picked a neutral statement but choosing to
| focus on only half of the people involved was an
| editorial choice which is reasonable to question.
| slingnow wrote:
| Why do you assume OP was blaming women? Nothing they said
| implies blame.
| Cuuugi wrote:
| Noone passed blame, simply noting the sexual revolution has
| made STD's more common-place.
| rjzzleep wrote:
| The effectiveness of the flu vaccine is kind of odd, but
| somewhat makes sense since it seems more like a moneymaking
| machine than something that actually has some worthwhile
| results(some people will probably jump on this statement). Most
| places don't even seriously market them for that very reason.
|
| 40% is terrible for something like gonorrhea, so unless it
| becomes much better you're better off being more diligent in
| your sexual escapades.
| nerdponx wrote:
| There has been a _huge_ push for annual flu vaccination in
| the last ~10 years in the USA. It was a favorite target of
| anti-vax conspiracy theorists long before Covid.
| chimeracoder wrote:
| > it seems more like a moneymaking machine than something
| that actually has some worthwhile results
|
| 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.
| droopyEyelids wrote:
| Its complex but you should try and separate your idea of
| "shame" from the concept of "consequence".
|
| People can change behavior to avoid consequence. Shame is a
| response to violations of morality. They're really quite
| distinct.
| inglor_cz wrote:
| "Its complex but you should try and separate your idea of
| "shame" from the concept of "consequence""
|
| 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.
| rjzzleep wrote:
| > 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.
|
| 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.
| JumpCrisscross wrote:
| > _public health insurance only covers older treatments
| because the new treatments are too risky for them with
| too little data on successful treatments_
|
| They're also more expensive.
| [deleted]
| onlyrealcuzzo wrote:
| I'd rather have a 40% less chance of getting gonorrhea than
| a 0% less chance.
| fsckboy wrote:
| > _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_
|
| 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.
| chimeracoder wrote:
| > 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.
| fsckboy wrote:
| > _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._
|
| 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.
| chimeracoder wrote:
| > 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
|
| 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.
| fsckboy wrote:
| >> _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._
|
| 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.
| chimeracoder wrote:
| > It doesn't matter what most people do, it only matters
| what the petri dishes for gain-of-function gonorrhea are
| doing. 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.
| inglor_cz wrote:
| "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?
| fsckboy wrote:
| > _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?
| legutierr wrote:
| So you are saying this functional vaccine exists, and has been
| approved by the FDA for another use, so that it can be used
| off-label, but that people do not use it because people don't
| know about it...
|
| ...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?
| vamin wrote:
| They may be referring to the meningitis vaccine:
| https://www.bmj.com/content/377/bmj.o997
| raylad wrote:
| This is not paywalled and has more info:
|
| https://www.cidrap.umn.edu/studies-highlight-meningitis-
| vacc...
| kemayo wrote:
| Googling "Neisseria gonorrhoeae vaccine" turned up...
| honestly, a lot of papers that're above my educational level.
| That said, this[1] WHO article from halfway down the results
| says that "observational studies indicating that vaccines
| developed for serogroup B Neisseria meningitidis might offer
| some protection against gonorrhoea, providing promise that
| gonococcal vaccines are biologically feasible", which I'd
| suspect is referring to the development that the OP is
| talking about. Please, feel free to follow up on that article
| if you have higher scientific literacy than I do. :D
|
| [1]: https://www.who.int/teams/immunization-vaccines-and-
| biologic...
| chimeracoder wrote:
| > What is this vaccine called, and for what other purpose has
| it been approved?
|
| 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.
| mzs wrote:
| tier 3 on most formularies:
| https://www.goodrx.com/bexsero/medicare-coverage
| chimeracoder wrote:
| Note that insurance will likely only cover it for on-
| label use.
| kungfufrog wrote:
| Interestingly, in Australia for young children, Bexsero is
| part of a recommended vaccine schedule (not compulsory).
| Both my kids have had it!
| chimeracoder wrote:
| > Interestingly, in Australia for young children, Bexsero
| is part of a recommended vaccine schedule (not
| compulsory). Both my kids have had it!
|
| 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.
| DennisP wrote:
| Can't a doctor administer it, if you self-pay?
| chimeracoder wrote:
| > Can't a doctor administer it, if you self-pay?
|
| 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.
| inglor_cz wrote:
| "most providers won't administer any medicine that they
| didn't source themselves, because technically they have
| no way of verifying the provenance."
|
| 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.
| SoftTalker wrote:
| > 1. Overuse of antibiotics in non-theraputic settings (e.g.
| agriculture)
|
| 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?
| binarycrusader wrote:
| Would it be this GSK Vaccine that just started a clinical study
| relatively recently?
|
| https://www.clinicaltrials.gov/ct2/show/NCT05630859
| chimeracoder wrote:
| > Would it be this GSK Vaccine that just started a clinical
| study relatively recently?
|
| 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..
| telotortium wrote:
| $300 doesn't sound like that much to me, if we're talking about
| the price in the developed world. Did you mean $3000? In the
| US, $300 sounds like what you might pay as coninsurance on a
| non-particularly-generous health care plan for treatments for
| much less harmful diseases - I would have paid for it out of
| HSA when I was on a high-deductible health plan, since that
| insurance only starts covering anything besides an annual
| physical and flu shots if you spend more than $2000 a year.
| onlyrealcuzzo wrote:
| Do you have a link to this vaccine data?
|
| Are there different types of gonorrhea, or is it 40% effective
| against all strains? And how long does the effectiveness last?
| ceejayoz wrote:
| You can't use an entirely unapproved drug off-label (with rare
| and individual exceptions; https://www.fda.gov/news-
| events/public-health-focus/expanded...).
|
| Off-label use is using an approved drug for a different medical
| purpose than the one it was approved for.
| chimeracoder wrote:
| > You can't use an entirely unapproved drug off-label
|
| 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.
| mmmmmkouff wrote:
| > I know how drug development works, but thank you.
|
| 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
| Scoundreller wrote:
| > until they find one that would be more effective and more
| profitable for them
|
| If I've learned anything over the past few years, the less
| effective the vaccine, the more profitable it is.
| nerdponx wrote:
| The most profitable vaccine would be highly effective, but
| wears off over time.
| gus_massa wrote:
| The mRNA vaccines have an effectiveness of approximately 90%.
| The inactivated virus vaccines have a "low" effectiveness
| like approximately 60% (that is not negligible!).
|
| Are the inactivated virus vaccine more profitable than the
| mRNA vaccines?
| Scoundreller wrote:
| Depends on production costs, can make the inactivated virus
| vaccine easily.
|
| mRNA vaccines were about 95% effective against symptomatic
| disease, but only against the targeted strain.
| mfer wrote:
| All 3 of these are related to optimizing for income. Even the
| first. They use so much antibiotics due to optimizing for
| income when it comes to the meat industry.
|
| Speaks to priorities
| nerdponx wrote:
| #2 and #3 seems like obvious places to direct public funds via
| government, being investments in public goods.
|
| 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.
| chimeracoder wrote:
| > #2 and #3 seems like obvious places to direct public funds
| via government, being investments in public goods. 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...
| sjsdaiuasgdia wrote:
| I think there's a few factors that contribute to there not
| being much political attention on gonorrhea treatment and
| prevention in the US.
|
| 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-...
| acdha wrote:
| I'd use HPV as a cautionary example: there has been a ton
| of opposition from religious people who more or less
| explicitly say that they need the fear of cancer to keep
| their kids from having sex before marriage. The fact that
| it can spread without sexual contact or that people get
| cheated on doesn't enter into the picture, it's entirely
| about the motivational power of fear.
|
| 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.
| mrguyorama wrote:
| Most of the signalling on the religious right for the HPV
| vaccine was _explicitly_ that if you let your daughter
| take it to protect her from an annoying and harmful
| cancer, she will become a sexual deviant and a whore.
| acdha wrote:
| Yeah, it was just disgusting both for what it said about
| how they viewed their children and the not inconsiderable
| number of women who are cheated on by "good Christian
| men" and find out the hard way.
| keepquestioning wrote:
| Can prophylactics stop Gonorrhea?
| jeffbee wrote:
| "This review of prospective studies published since June 2000
| has identified evidence that consistent condom use is
| associated not only with reduced transmission of HIV and with
| reduced acquisition of urethral infection among men, but also
| with reduced acquisition of gonorrhoea by women."
|
| https://www.scielosp.org/pdf/bwho/v82n6/v82n6a12.pdf
| fsckboy wrote:
| just want to mention, maybe I don't hang around the right
| people, but in my experience, where oral sex is common, use of
| rubber barrier methods during oral sex is very uncommon, and
| yes, you can catch the clap that way.
| https://www.dictionary.com/e/slang/the-clap/
|
| 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.
| hn_throwaway_99 wrote:
| Thanks for posting this. "Pharyngeal Gonorrhea" is actually
| where most of these drug resistant strains have been found,
| at least in the UK (can dredge it up somewhere but I read
| this recently when this was in the news).
|
| 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.
| keepquestioning wrote:
| What are plastic prophylactics?
| chiph wrote:
| Prophylactics made of plastic. i.e. Condoms made from latex
| rubber or long-chain polymers. Not sheepskin[0] or other
| natural materials.
|
| [0] Condoms made from sheepskin (really, sheep intestine)
| help prevent pregnancy but absolutely do not protect either
| party from STD transmission.
| kemayo wrote:
| Mostly, yes. (It's one of the "sexual fluids touching a moist
| area" ones. So there's things a prophylactic won't quite cover,
| but... mostly.)
|
| https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/g...
| giantg2 wrote:
| I mean, the answer is a "yes, in theory". True, prophylactic
| _gear_ has limitations. However, there 's also prophylactic
| planning/techniques, or auxiliary gear that could cover those
| other things.
|
| 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.
| recursivedoubts wrote:
| as surely as water will wet us
|
| as surely as fire will burn
|
| the gods of the copybook headings
|
| w/terror & slaughter return
___________________________________________________________________
(page generated 2023-01-20 23:02 UTC)