This project was done in BIOL 453, Immunology. The CDC has classified antibiotic resistant gonorrhea as an "urgent threat" in its 2013 antibiotic resistance threat report. Education for at risk groups is essential to slow the threat of this disease.

1. Why Should You Care About Antibiotic Resistant Gonorrhea?
Can my immune system heal gonorrhea like it would an infected cut or a cold? Can’t I just get some antibiotics from my doctor and be better in a week?
That does sound a little scary. But, why should I be concerned?
In the CDC’s 2013 antibiotic resistance threat report, N. gonorrhoeae is one
of three microorganisms classified as having an “Urgent” threat level.
Kevin Hugins
Biology 453
Nevada State College
Spring 2014
What Causes Gonorrhea?
Gonorrhea, also known as
the Clap, Morning Drip or
Running Rage, is caused
by Neisseria gonorrhoeae,
a gram negative diplococci
bacteria.
What Are The Symptoms?
The most common
symptoms include:
● Painful or Frequent
Urination
● Anal Itching,
Discomfort, Bleeding
or Discharge
● Abnormal Discharge
from Vagina or Penis
● Sore Throat
● Fever
● Fatigue
Often no symptoms appear for 30 days or more after infection.
Up to 50% of infected females do not show symptoms.
However:
You can still transmit the infection even if you do not have
symptoms.
(Web MD)
Are there any complications if gonorrhea is left untreated?
General:
● Cellulitis
● Sepsis
● Arthritis
● Endocarditis
● Meningitis
● Infertility
Men:
● Epididymitis
● Prostatitis
Women:
● Pelvic Inflammatory
Disease
● Tubal Pregnancy
● Abscess In Ovaries
● Endometritis
● Miscarriage
Newborns:
● Serious Infections of Skin, Eyes, Blood, Heart, or Brain/Spinal fluid.
N. gonorrhoeae has evolved many effective strategies to avoid detection and destruction by our immune system.
The complement system is made up of approximately 25
different proteins that circulate throughout the body. The
proteins have various roles in assisting cells of the immune
system to destroy pathogens. One function of complement
proteins is to form pores in invading bacteria which will cause
the bacteria to lyse and die. Researchers have found that N.
gonorrhoeae can inhibit this function and thus evade
destruction from complement.
(Kirkcaldy 2011)
(Liu 2011)
Neutrophils are the most abundant immune
system cell in the human body. Neutrophils
act by phagocitizing invading bacteria. N.
gonorrhoeae has the ability to survive inside
the vacuole of neutrophils and avoid
destruction by enzymes within the cell
allowing the bacteria to survive inside the
neutrophil.
(Liu 2011)
N. gonorrhoeae Causes reduced levels of IL-2. IL-2 is critical for T-
Cell and B-Cell activation and differentiation, activation of
monocytes and stimulation of NK cells. This effectively reduces the
ability of the entire immune system to mount a successful
immunological response. This also prevents the immune system
from producing memory cells. As a result there is no acquired
protection from future infections.
(Geisler 2008)
N. gonorrhoeae enhances TGF-B
production which inhibits the formation of
Th-1 and Th-2 CD-4 T-Cells. These are vital
for defense against bacterial infections. This
in turn decreases the immune response for
B-Cells and phagocytes.
(Liu 2011)
The Center For Disease Control (CDC) reports that 30% of reported
cases of gonorrhea in 2013 were resistant to one or more antibiotics.
Over 3% of cases were resistant to cephalosporins which are considered
the last line of antibiotic defense that is currently available to fight
bacterial infections.
(CDC Threat Report 2014)
(Morbidity Report 2012)
How does N. gonorrohoeae develop antibiotic resistance?
N. gonorrhoeae is very adept at mutating through:
● Horizontal Gene Exchange
● Genetic Recombination
● Allelic Polymorphism
● Phase-Variable Expression
Gonorrhea is constantly mutating by rearranging its own genes and by bringing in and incorporating genes from other live
cells and from free genetic material from dead cells. Not only does this help N. gonorrhoeae to rapidly evolve its antibiotic
resistant properties, it also provides one final roundhouse kick to our body’s immune system. Due to this ability to mutate,
N. gonorrhoeae can avoid detection by the immune system and prevent adaptive immunity by continuously changing
proteins and antigens on its surface. The limited defense our immune system is able to develop is soon rendered useless
as the bacteria mutates.
(Kirkcaldy 2011)
(Liu 2011)
OK, this is entirely too much information to remember. Can you sum it up in 4 bullet points?
● Antibiotics are becoming unable to fight gonorrhea effectively.
● Innate Immunity is compromised and can not launch a full scale response.
● No adaptive immunity occurs because T-Cells are not activated.
○ There is no protection from future infections either.
● If neither your immune system nor the administration of antibiotics are able to effectively kill N. gonorrhoeae
there is an ever increasing risk of experiencing the severe complications that result from a gonorrhea infection if
you contract one.
NV has a reported infection rate of 83.1
cases of gonorrhea per 100,000 people.
The actual rate is higher due to many
unreported infections. That means that in
Clark County there will be over 1,700
REPORTED cases this year.
(CDC 2014)
Additionally:
● 70% of reported infections in men are of
the ages of 15-29.
● 80% of reported infections in women are
of the ages 15-29.
● In 2011 the infection rate for 20-24 year
olds in NV was 325 per 100,000.
Remember:
Up to 50% of infected women
have no symptoms
Now I am concerned. How can you catch it?
Gonorrhea is highly transmissible:
● Men have up to a 25% chance of getting gonorrhea if their
partner is infected.
● Women have up to a 60% chance of getting gonorrhea if
their partner is infected.
(Groopman 2012)
Not only is gonorrhea contracted from vaginal or anal
intercourse, N. gonorrhoeae frequently resides in the
pharynx resulting in high transmission rates from oral sex.
(Groopman 2012)
I didn’t realize how serious gonorrhea has become. What should I do to protect myself?
1. Get tested:
Remember you or your partner
can be infected with
gonorrhea but have no
symptoms.
2. ALWAYS use a condom:
Remember not only is gonorrhea
transmitted through intercourse but
is also highly contagious through
oral sex.
3. Only have one partner at
a time:
Multiple partners multiply your
chance for infection.
4. Educate your friends:
Remember, many people
falsely believe oral sex is a
safe alternative that does
not necessitate condom
use and the historical
attitude is that antibiotics
are a quick fix.
References
Antibiotic Resistance Threats in the United States, 2013. (2014, March 10). Retrieved March 23, 2014, from http://www.cdc.gov/drugresistance/threat-report-2013/
Geisler, W. M., Wang, C., Tang, J., Wilson, C. M., Crowley-Nowick, P. A., & Kaslow, R. A. (2008). Immunogenetic Correlates of Neisseria gonorrhoeae Infection in Adolescents. Sexually Transmitted Diseases, 35(7), 656-661. doi: 10.1097/OLQ.0b013e31816b6593
Gonorrhea-What Happens. (n.d.). Retrieved March 24, 2014, from http://www.webmd.com/sexual-conditions/tc/gonorrhea-what-happens
Groopman, J. (2012, October 1). Sex and the Superbug. The New Yorker. Retrieved March 24, 2014, from http://www.newyorker.com/reporting/2012/10/01/121001fa_fact_groopman?currentPage=all
Kidd, S., Kirkcaldy, R., Ye, T., Papp, J., Trees, D., & Shapiro, S. J. (2012, August). Cephalosporin-Resistat Neisseira Gonorrhoeae Public Health Response Plan (USA, Centers for Disease Control and Prevention, Division of STD Prevention). Retrieved March 24, 2014, from http://www.cdc.gov/std/treatment/ceph-r-
responseplanjuly30-2012.pdf
Kirkcaldy, R. D., Ballard, R. C., & Dowell, D. (2011). Gonococcal Resistance: Are Cephalosporins Next? Current Infectious Disease Reports, 13(2), 196-204.
Liu, Y., Feinen, B., & Russell, M. W. (2011). New Concepts in Immunity to Neisseria Gonorrhoeae: Innate Responses and Suppression of Adaptive Immunity Favor the Pathogen, Not the Host. Frontiers in Microbiology, 2. Retrieved from http://journal.frontiersin.org/Journal/10.3389/fmicb.2011.00052/full
USA, Centers for Disease Control and Prevention, Division of STD Prevention. (2012, August 10). Morbidity and Mortality Weekly Report (MMWR). Retrieved March 24, 2014, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6131a3.htm?s_cid=mm6131a3_w
USA, Centers for Disease Control and Prevention, Division of STD Prevention. (2014, January 07). 2012 Sexually Transmitted Diseases Surveillance. Retrieved March 24, 2014, from http://www.cdc.gov/std/stats12/gonorrhea.htm
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