Sexual Health Thursday January 28, 2016

The Future Of Sexual Health: Less Treatment, More Prevention?

What does the sexual health future hold if antibiotics become ineffective?

Despite huge leaps in healthcare technology over the past few years, we're heading backward with regards to infection treatments. Why? Because bacteria is fighting back. Increasing bacterial resistance to antibiotics is a cause for worldwide concern.

What is antibiotic (antimicrobial) resistance?

It's the ability of bacteria to resist drugs. This means that an infection cannot be cured. It's a real problem for STI treatment because we're reliant on antibiotics to cure infections and prevent large-scale outbreaks.

Overuse of antibiotics has allowed resistant strains of infections to breed. This has given rise to 'superbugs' like MRSA and resistant gonorrhoea. Without effective antibiotics; STI treatments, safe births, safe operations and chemotherapy are all in danger.

Are we really overusing antibiotics?

Statistics show that in England, the number of prescriptions for antibiotics are rising, yet half of these are 'inappropriate'. Why is this? Perhaps it's because a large part of the population has grown up with antibiotics on hand. They haven't lived in a time when doctors didn't give out a course of pills to clear up an infection. They simply take them for granted.

These are some of the reasons superbugs have developed resistance to antibiotics:

  • patients missing doses

  • keeping some tablets for later

  • sharing with others

  • not taking at regular intervals

  • demanding antibiotics when not needed

All this means antibiotics are losing their effectiveness. It's a big threat to patient safety.

What are medical professionals doing to tackle this?

Doctors are cutting back on prescription antibiotics now, but it's easy to see why they might have been over-prescribing. A surgery full of demanding patients, with more on the appointment line, is a big pressure to work under.

Medical professionals are looking at:

  • Unnecessary prescribing

  • Choosing the wrong antibiotic for the infection

  • Using broad spectrum antibiotics instead of targeted ones

  • Inappropriate doses or durations.

What happened if you got an STI before antibiotics?

Before antibiotics were discovered, a paper-cut could kill you. Any route into the body allowed infection to enter and breed. An overwhelming amount of bacteria could lead to blood poisoning, limb loss or death, and STIs were no exception.

tablets spilling out of bottle

Throughout history STI treatment has been a public health priority. We were saved with the arrival of antibiotics, but could soon plunge back into a no-treatment-nightmare scenario.

In the past, a dose of gonorrhoea was incurable, resulting in disfigurement, painful symptoms and infertility. Left unchecked it could lead to death.

Past treatments for STIs included the use of mercury or arsenic, or more recently a dose of malaria. STIs with visible sores were lanced to release the build-up of pus, and when the urethra became blocked, a catheter was induced to remove the blockage.

It was not a good place to be. Antibiotics were the answer to everyone's prayers - but now it seems we've abused the privilege.

Are STIs becoming resistant to antibiotics?

In short, yes. Studies have shown gonorrhoea (Neisseria gonorrhoeae) is swiftly developing resistance to the remaining treatment. It fights every antibiotic thrown at it, and there are not many options left. There's a real possibility that gonorrhoea may become incurable again.

Should we be focussing on the safe sex message, in case we run out of antibiotic options?

Safe sex is always important but now we need even more hard-hitting campaigns. With antibiotics on their last legs, people must take responsibility for their heath. Condom and latex dam use is vital. If STIs can't be treated they must be avoided.

In the meantime, people continuing to take antibiotics for easily preventable STIs just adds to the problem of resistance.

Prevention is essential; vaccines don't exist yet and if the only cure disappears, that night of drunken passion could end up disfiguring, destroying chances of starting a family, and could even kill.

Can you have an STI and not know it?

Yes it's possible, particularly with chlamydia and gonorrhoea which can have no symptoms. The rule is, if you've had unprotected sex you should get a check up. STIs can sit inside your body silently causing untold damage that you won't realise until it's too late, such as infertility.

How can we help save antibiotics?

Some researchers and commentators believe that antibiotics should be made expensive so that doctors are less likely to prescribe them, but another route is to safeguard our antibiotics.

Public Health England has created the Antibiotic Guardian Campaign to raise awareness and protect our remaining antibiotics from overuse. They have set out a five-year plan for action.

People should make use of self-care and home remedies for colds, coughs and sore throats, as well as seeking advice from pharmacists rather than GPs where appropriate. Practising safe sex will also slow down the spread of STIs and cut antibiotic use.

Are any new antibiotics being discovered?

The last discovered antibiotic was found in the 1980s and resistance has outpaced discovery.

bacterial culture in dish

However, new research from the Northeastern University in Boston, Massachusetts, has discovered a new strain of antibiotic from the soil. Laboratories can culture microbes but when placed in the earth they take on a life of their own. The soil's chemistry has produced new cultures that may hold the key to antibiotic resistance.

Professor Lewis, who led the team, said that 25 new antibiotics have been uncovered, with one - Teixobactin - looking particularly hopeful. Teixobactin is toxic to bacteria but not to lab animals. It cured MRSA in mice with one dose.

Researchers believe this antibiotic is different because it targets building fats of the bacterial wall. Professor Lewis claimed it was 'an antibiotic that essentially evolved to be free of resistance.'

What does the future hold regarding STI treatment?

Public Health England report that cases of gonorrhoea have risen by 20% and 32% in gay men. There are 20 million reported new cases in the USA each year.

If we continue to pick up STI infections whilst our only line of defence is crumbling, then our quality of life will dramatically decrease. It's a dark future for sexual health without any antibiotics.

Many STIs have painful symptoms such as ulcers and pus-filled lesions, itching discharge, painful bowel movements and eventual spread of the infection to other body parts such as the eyes, blood and brain. With no cure, it's a life of misery until new advances are made.

However, scientists are working hard to discover new antibiotics. If they find a new medication hopefully we'll have learned not to squander it.

Harbouring a new antibiotic resource will be particularly important in the future because it could the last one ever found and the only means to cure an STI.


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