Why We All Need To Worry About Super Gonorrhoea!
Most of the time, bacteria are not the bad guys we think they are. In fact, many of the trillions of bacteria living in our gut and on our skin are playing crucial roles in keeping us healthy.
These often-called “good bacteria” help help with our digestion, enable us to fight off “bad bacteria” and even prevent us from from bleeding to death– to give just a few examples!
But the fever that accompanies that strep throat infection?
Or the rampant diarrhea and vomiting that follow the the late-night kebab complete with e-coli dressing?
Yeah, the bacteria that cause those unpleasant symptoms, we would definitely prefer to live without! Thank heavens we have antibiotics because a week of tablets should have us waving goodbye to these unwelcome guests – right?
Maybe, maybe not.
Let’s start by making sure we know that a bacterium is a single, tiny cell full of DNA, and that DNA is divided up into sections called genes. These DNA-genes are the instructions that bacterium follows to make everything it needs to survive, thrive and oh, reproduce!
And bacteria are truly excellent at that last part.
Unlike in human courtship, there’s no bacterial Tinder or match.com! Bacteria don’t need a mate to make new bacteria, they merely copy their DNA and divide, putting that copied DNA into a new cell and the result is two cells with identical DNA.
Using this tactic of copying and dividing, the numbers of bacteria become really big, really quickly. If we start the stopwatch with a single bacterium on rice left over from our Netflix and take-out, in around twenty minutes our bacterial cell will have copied its DNA, divided and our first cell has become two.
Not a huge problem.
Give those two cells a further 20 minutes to divide and now there are four bacterial cells flavoring the left overs.
Still not especially worrisome.
However, the mathematics of this cellular doubling (or replication rate as scientists call it) is crazy – six hours from that single starting cell dividing every 20 minutes, there will be more than a quarter of a million bacterial cells and ..
.. food poisoning will be just a forkful away!
But this super quick DNA copying that’s crucial to the rapid growth of bacterial populations, makes mistakes and a few of the copied genes won’t read quite the same as the original - that’s what’s meant when we hear the term “genetic mutations”.
There’s something we need to be clear about here:
Bacteria don’t purposely mutate their DNA, they’re not sneaky and they’re not trying to infect us.
They’re simply cells, programmed to copy their DNA, divide, and repeat!
Some of these accidentally, carelessly produced mutations given to the newly minted bacteria will be a disaster and maybe, even lethal to the bacteria that receive them.
Some won’t make a difference either way to a bacterium’s wellness – the bacterium inherits the bacterial equivalent of curly hair instead of straight hair, brown eyes instead of green ones, that’s all.
But a few might turn out to be very helpful to these intruders.
Imagine the scenario - we’re under siege by a bacterial infection but hurray, we take our prescribed antibiotic and brilliant, all of the bacteria are destroyed.
Except one.
During our infection, one bacterium in our tonsils or our ear accidentally gained a genetic mutation that made it resistant to the actions of our prescribed antibiotic. And if that copying error allows the bacterium to survive and pass on that useful mutation to its offspring?
Well, the story of super gonorrhoea shows us exactly how much trouble can result.
Worldwide, more than 60 million people every year are diagnosed with gonorrhoea, a sexually transmitted bacterial infection (STI) that causes everything from infertility to the oozing of pus from places most of us would prefer not to have to show to our doctor.
But we can treat it with antibiotics, right?
Hmm, maybe.
Although there are over a hundred different antibiotic drugs currently available for use, they’re all needed because each type of bacteria is susceptible to a very small proportion of that number - the best antibiotic for destroying strep-throat bacteria for instance, might be pretty unimpressive when it comes to extinguishing those yukky, ear-infection causing bacteria.
In the case of the bacterium, N.gonorrhoeae responsible for the unpleasantness of gonorrhoea, back in 1993 doctors had only three reliable antibiotics to terminate its human residency. Today, after a couple of decades of random, useful mutations in N.gonorroeae’s genes, it’s resistant to all but two of that huge collection of antibiotic drugs.
I’ll say that again.
There are only two drugs in the whole, enormous world, capable of killing a bacterium currently infecting 60 million people a year!
That’s why gonorrhoea became “super gonorrhoea”, because it’s super difficult to treat! And if these bacteria continue gaining resistance at the same rate then super gonorrhoeae will become untreatable by the middle of the century.
Yikes.
Understandably, readers in a committed relationship for example, might not be especially worried about untreatable STIs.
Okay, we’ll talk urinary tract infections (UTI) instead:
· By the time they’re 24, one third of all women will have needed antibiotic treatment for at least one UTI.
· Every year, more than one million catheter-using Americans develop a UTI.
· UTI’s are so common as we age, that up to 2/3 of care homes’ entire drugs budget are being eaten up by antibiotics to treat these infections.
It seems more than likely therefore, that all of us at some point in our lives, will have a UTI that needs treating.
And that’s a growing concern.
In 2015, the British National Health System (NHS) collected data from over 1 million people suffering with a UTI and found that 29% of the patients were resistant to the first-choice antibiotic their doctors prescribed.
It gets worse.
The NHS continued collecting data over the next twelve months by which time that antibiotic-resistant number had risen to 34%.
Add in the fact that as many as 1 in 10 people are carrying antibiotic-resistant UTI-causing E.coli bacteria in their gut and it’s not hard to see what’s happening here.
Like those pesky N.gonorroeae bacteria, E.coli have been busy duplicating themselves and making those DNA-copying errors, some of which, really worked out for them - the mutated genes have given the bacteria the ability to destroy the very antibiotics previously given to destroy then.
Kind of ironic, eh?
We’ve been talking here about genetic mutations making N.gonorroeae and E.coli antibiotic-resistant variants, but this is happening with many, different disease causing bacteria and is the reason why the World Health Organization states that “Antibiotic resistance is one of the biggest threats to global health, food security, and development today”.
Truly terrifying.
Similar processes are at play in the frightening rise of COVID variants too as well as why we have to have a new flu vaccination every year.
But that story’s a little different because viruses are as similar to bacteria as a rock is to a fish - keep an eye out for that conversation!
Stay curious,
Doctor P
