The Problem with Antibiotic Resistant STDS

When it concerns sexually transmitted diseases, the process of an infection forming antibiotic resistance to STD treatment is complex at the micro level. Most of the time, the application of antibiotics provides the best solution as they would normally target a critical function that keeps the organism alive. When it comes to the most frequently used STD antibiotics, the process goes as: 

• Penicillin and cephalosporins destroy the cell wall: When the cell wall is destroyed in bacteria, the cell loses its structural integrity, leading to cell lysis and death.

• Tetracycline and macrolide inhibit protein synthesis: When protein synthesis is inhibited in bacteria, they are unable to produce essential proteins for their growth and function, ultimately leading to bacterial cell growth arrest and often cell death.
• Fluoroquinolones disrupt DNA replication: When DNA replication is disrupted in bacteria, it prevents the accurate copying of genetic material, leading to mutations, impaired cell division, and potentially cell death.
• Sulfonamides and trimethoprim ruin the metabolic pathways: When metabolic pathways are disrupted in bacteria, it impairs their ability to generate energy, synthesize essential molecules, and carry out vital biochemical processes, often resulting in bacterial growth inhibition or its death.
• Rifamycins play havoc with the DNA transcription: When DNA transcription is disrupted in bacteria, it prevents the formation of RNA molecules from DNA templates, hindering the synthesis of essential proteins and interfering with bacterial growth and function.

While not all of these STD antibiotics can be used for each disease, they each allow a doctor an extensive toolkit to treat a patient. 

Due to how fast bacteria from an STD infection reproduces, the possibility of a genetic mutation is always present. While antibiotics are designed to work fast and eradicate sexually transmitted diseases, they can be effectively reduced if not taken properly or overused. Additionally, an STD infection can become antibiotic resistant during the initial infection or reinfection by the following: 

• Horizontal Gene Transfer: An STD infection can exchange genetic material with other bacteria through processes like conjugation, transformation, and transduction. This means that antibiotic-resistant genes can be transferred from one bacterium to another, even between different species. This transfer of resistance genes can occur within the same environment, such as the human body or a hospital setting, leading to the spread of resistance.
• Selection Pressure: The use and misuse of antibiotics create a selective pressure on bacterial populations. When antibiotics are used to treat infections, they kill or inhibit the growth of susceptible bacteria, but any resistant bacteria present can survive and reproduce. Over time, this selective pressure allows resistant bacteria to become more prevalent in a population.
• Incomplete Antibiotic Courses: If a patient does not complete a full course of antibiotics as prescribed by their healthcare provider, there is a risk that some bacteria may survive and develop resistance. Incomplete treatment can lead to the survival of the fittest, where only the most resistant bacteria remain.
• Overuse and Misuse: Antibiotics are sometimes overused or inappropriately prescribed, such as for viral infections where antibiotics have no effect. This contributes to the selective pressure for resistance, as it exposes bacteria unnecessarily to antibiotics, allowing resistant strains to emerge and proliferate. 

Despite being the minority of cases, antibiotic resistance in sexually transmitted diseases is a worry of medical providers in the United States. Especially in patients who don’t practice safe sex and recognize when they have an infection that needs STD treatment. 

If you are sexually active, you are susceptible to getting a sexually transmitted disease. The infection is most often the result of unprotected sexual intercourse between two adults of either gender, but can also be the result of infected skin coming into contact with the genitals, sharing needles, orally, and during childbirth. Additionally, some STDs can go undetected or go dormant, meaning they can infect someone else if left untreated. Other times symptoms can be mistaken for another condition, such as a cold, before going dormant, leaving an individual to believe they had gotten over "being sick" when it was actually related to their sexual health.

 In the event that it is an active case or temporarily active, here are the most common symptoms: 

• Unusual Genital Discharge: A clear sign in men and women, STD discharge is liquid that comes out of the penis or vagina that can either appear or smell out of the norm. A telltale sign when accompanying other specific symptoms, the most common causes include: 
  • Chlamydia: Thin, milky, or clear discharge.
  • Gonorrhea: Yellow or greenish discharge.
  • Trichomoniasis: Frothy, greenish-yellow or gray discharge in women.
• Painful or Burning Urination: Many STDs can cause pain, discomfort, or a burning sensation during urination or sexual intercourse. The most common culprits typically are chlamydia, gonorrhea, and herpes, but can additionally be caused by non-STD infections like a urinary tract infection or a vaginal yeast infection. 
• Genital Sores or Ulcers: These can appear as sores, ulcers, or blisters and appear in/around the mouth, genitals, and anus. 
  • Herpes: Painful sores or blisters on the genitals or mouth.
  • Syphilis: Painless sores (chancre) on genitals, anus, or mouth.
  • Genital Warts: Warts on the genital or anal area.
• Itching or Irritation in Genital Area: Itching or irritation in the genital, anal, or mouth areas can be a symptom of various STDs, including: 
  • Pubic Lice: Severe itching and irritation in the pubic area.
  • Scabies: Intense itching and a rash in the genital and other body areas.
• Lower Abdominal Pain: Pelvic pain or lower abdominal pain can be associated with some STDs, particularly if the infection has progressed or caused complications.
  • Pelvic Inflammatory Disease: Caused by untreated chlamydia or gonorrhea, it can lead to lower abdominal pain.
• Flu-Like Symptoms: Some individuals with early-stage HIV infection may experience flu-like symptoms, such as fever, fatigue, and swollen lymph nodes. 
• Rash: STDs like syphilis and HIV can cause skin rashes that vary in appearance. In both conditions, the rash is not isolated to the genitals and does not necessarily have a specific appearance. 
• Rectal Symptoms: STDs can affect the rectum and cause symptoms such as rectal pain, bleeding, or discharge. Rectal gonorrhea and chlamydia both cause this symptom. 
• Painful or Swollen Testicles: Infections such as epididymitis, which can be caused by certain STDs like chlamydia or gonorrhea, may result in pain or swelling of the testicles.
• Swollen Lymph Nodes: Swollen lymph nodes in the groin, neck, or armpits can be a sign of an infection, including some STDs. Syphilis is a common example that swells the lymph nodes. 

When you notice STD symptoms or are sexually active, it's important to get regular STD testing in the event that you do need STD treatment, as it being left untreated can lead to long term health complications. Fortunately, Call-On-Doc makes the process entirely easy by offering affordable and easy-to-access STD testing. While we do offer STD treatment before a positive test result, we do urge patients to get tested after treatment to make sure the infection has cleared. Additionally, we offer 50% off partner treatment and discreet prescription delivery to your chosen pharmacy or doorstep. In the event you have to go to a pharmacy, your privacy is kept secure because the pharmacist only knows the medication, not what condition you are being treated for. 

In the case of mycoplasma and ureaplasma, treatment can sometimes be tricky due to each having a natural resistance to some antibiotics. Call-On-Doc is one of the first and few that offers treatment and testing for mycoplasma and ureaplasma and follows the CDC guidelines for best treatment options along with your medical and sexual history. Some signs to get lab testing or a test of cure, as well as a follow-up treatment plan, are:

• Persistent Symptoms: If your symptoms persist or recur after completing a full course of antibiotic treatment for an STD, it could be an indication of antibiotic resistance or an STD that has not been treated (for example, treating chlamydia when you have chlamydia and gonorrhea).
• Treatment Failure: Treatment failure occurs when the prescribed antibiotics do not effectively clear the infection. If you do not experience improvement in your symptoms or if they worsen after completing antibiotic treatment, it raises concerns about resistance.
• Recurrent Infections: Frequent or recurrent episodes of the same sexually transmitted disease, even after receiving appropriate STD treatment.
• Positive Culture and Sensitivity Testing: Laboratory tests, such as culture and sensitivity testing, can help identify antibiotic resistance. If the culture shows the presence of the STD-causing bacteria and the sensitivity testing reveals resistance to commonly used antibiotics, this is a clear indication of antibiotic resistance.
• Reinfection by Sexual Partners: After a successful treatment, getting reinfected with the same STD can potentially cause the development of an antibiotic resistant strain. 

Regardless of whether it's suspected of being antibiotic resistant, it's important to get a “test of cure” for your STD infection. This means that after the treatment has been successfully completed, a patient will get tested again for the same condition to be to be sure the infection is gone. In the case of CallonDoc and most other medical providers, all that’s needed is a complete another test for the same condition.

While not widespread in the United States yet, the CDC estimates that around two million Americans get infected with difficult-to-treat strains annually. (3) The most common STDs responsible for the continual rise in cases are:

Chlamydia

Gonorrhea

Syphilis

Whereas cases of antibiotic resistant syphilis and chlamydia are not necessarily prevalent in the United States, cases of gonorrhea have been recorded nationally. Not isolated to a single strain, measures by the CDC are already being taken to combat the development and reduce the spread. (4)

Antibiotic resistance in sexually transmitted diseases is a concerning issue due to its potential impact on public health and individual well-being. When STD-causing bacteria or viruses become resistant to antibiotics, it becomes increasingly difficult to treat these infections effectively. This can lead to prolonged or recurrent symptoms for affected individuals, increasing their discomfort and the risk of complications. Additionally, antibiotic-resistant STDs can contribute to the continued spread of these infections within communities, potentially leading to higher transmission rates and public health challenges. 

In the instance where you are infected with an antibiotic resistant STD, medical intervention by a healthcare provider will be necessary. That is because the measures needed for STD treatment in this case will need to be exact, applied correctly, and in a form that should not be handled by untrained professionals. An example of this is the current CDC-approved treatment for antibiotic resistant gonorrhea, which is a 500 mg injection of ceftriaxone. 

Communication between sexual partners and between doctor and patient is critical in managing STD transmission. Those who are sexually active are encouraged to have each partner and themselves regularly tested so any potential STD infection is caught promptly. Whereas the normal recommendation for regular testing is annual, it’s also advisable to do so in response to symptoms, before starting a new sexual relationship, after a high-risk encounter, and during prenatal care. 

When it comes to communication between you and your healthcare provider, it's important to provide as much detail as possible. Symptoms noticed, especially if they involve the genitals, need to be conveyed to the doctor so the STD treatment can be as effective as possible. When he or she asks questions, any information shared will be, by law, kept private. 

While sometimes not routine, a test of cure confirms whether the STD treatment has proven effective. While each infection may require a set time after treatment for another test to provide an accurate answer, doing so is the best way to confirm if your body is free of the condition. In the time between the treatment begins and when taking the test of cure, it is best to remain abstinent and inform partners of what you are doing. This allows for maximum effectiveness as your partners should be getting tested and treated as well during this time, which can be half off with CallonDoc’s partner treatment program!

While your chances of avoiding a sexually transmitted disease are heavily improved through abstinence and mutual monogamy, committing to safe sex practices is crucial when sexually active. Not only the best way to avoid catching an antibiotic resistant STD, but STD infections in general, here are the top recommendations for having safe sex: 

• Condom Use: Proper and consistent condom use is one of the most effective ways to prevent the transmission of STIs, including HIV, chlamydia, gonorrhea, and syphilis. Both male and female condoms are available. However, it is important to note that not all STDs can be prevented through condom use, but they significantly decrease your chances of infection.
• Regular Testing: Get tested for STIs regularly, especially if you have multiple sexual partners or engage in high-risk sexual behaviors. Regular testing can help detect infections early and reduce their spread.
• Limiting Sexual Partners: Reducing the number of sexual partners can lower the risk of exposure to STIs. Fewer partners mean fewer opportunities for transmission.
• Vaccination: Get vaccinated against STIs for which vaccines are available. For example, vaccines are available for human papillomavirus (HPV) and hepatitis B.
• PrEP (Pre-Exposure Prophylaxis): PrEP is a medication that can be taken by individuals at high risk of contracting HIV to prevent infection. It is prescribed by healthcare providers.
• PEP (Post-Exposure Prophylaxis): A preventive treatment involving the use of antiretroviral drugs or antibiotics, and it helps with STD infection by reducing the likelihood of acquiring the infection after potential exposure.
• Regular Health Checkups: Visit a healthcare provider regularly for sexual health checkups, including cervical cancer screenings (Pap smears for individuals with a cervix) and HPV testing.
• Open Communication: Have open and honest communication with your sexual partner(s) about sexual health, testing history, and prevention strategies. Discuss boundaries and consent.
• Proper Lubrication: Using water-based or silicone-based lubricants with condoms can help reduce the risk of condom breakage during intercourse.
• Dental Dams: For oral sex on the genitals or anal area, use dental dams, which are thin sheets of latex or polyurethane, to provide a barrier.

Implementing safe sex measures and communicating with each partner you choose to be sexual with is entirely important to curbing the spread of normal and antibiotic-resistant STDs. Call-On-Doc offers testing, treatment, and further information on each of the most common sexually transmitted diseases in the United States. Check out our consultation page and blog below for more information!

1. “Sexually Transmitted Infections.” Office of Disease Prevention and Health Promotion, Healthy People 2030, https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections.
2. Lobanovska M, Pilla G. Penicillin's Discovery and Antibiotic Resistance: Lessons for the Future? Yale J Biol Med. 2017 Mar 29;90(1):135-145. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369031/.
3. Ambardekar, Nayana. “Antibiotic-Resistant STDs: FAQ.” WebMD, 14 May 2023, https://www.webmd.com/sexual-conditions/antibiotic-resistant-std-faq.
4. “Drug-Resistant Gonorrhea - STD information from CDC.” CDC, https://www.cdc.gov/antimicrobial-resistance/index.html.