The global crisis of growing antibiotic resistance could create a superbug that kills you and everyone you know. If the abstract thought of impending doom doesn’t scare you, then consider the impact of resilient bacterial species on your sex life.

Gonorrhea, one of the most common sexually transmitted infections, used to be easily treatable using broad-spectrum antibiotics. In recent years, however, the causative bacterium, Neisseria gonorrhoeae, has increasingly acquired resistance to several of our go-to medical agents.

If ignored, gonorrhea can lead to inflammation of the throat, urethra, cervix, or anus; at times eventually developing into pelvic inflammatory disease in women and infertility in both genders.

The current international guidelines, supported by the World Health Organization, European Centre for Disease Prevention and Control, and American Centers for Disease Control and Prevention, recommend a dual therapy of ceftriaxone and azithromycin.

But case reports from the UK and the US show strains of N. gonorrhoeae that are resistant to both ceftriaxone and azithromycin are out there, ready to spread between unfortunate hosts with bad safe-sex practices.

To determine the state of gonorrhea in China, researchers from several institutions reviewed 3 years of bacterial culture data gathered by the China Gonococcal Resistance Surveillance Programme (China-GRSP) between 2013 and 2016. The 3,849 strain samples were taken from affected patients during clinic visits in seven provinces and tested for antibiotic susceptibility using international laboratory standards.

According to results published in PLOS Medicine, nearly 19 percent of gonorrhea cases are resistant to azithromycin, meaning the infection will not be cleared with the medication. And about 11 percent of strains showed lower susceptibility to ceftriaxone; the drug might be able to kill some of the N. gonorrhoeae bacteria, but the dose required to do so has increased. (At some point, the strain will either become largely unaffected, or the quantity needed to hurt it will induce such extreme side effects that the drug is rendered useless.)

Cases treated in 2016 showed a troubling 3.3 percent rate of concomitant resistance to azithromycin and decreased susceptibility to ceftriaxone – nearly double the 1.9 percent found in 2013.

The authors conclude: “The high and increasing prevalence of [azithromycin resistance and decreased susceptibility to ceftriaxone] found in the current study suggests the need for further consideration and validation of an appropriate regimen for treatment of gonorrhea in China."

Exactly what treatment Chinese public health officials could adopt in place of the azithromycin/ceftriaxone combination, when it becomes ineffective, remains unknown. In the US, ceftriaxone and its relatives in the cephalosporin family are the last recommended line of defense left against multi-drug-resistant strains. Once these drugs fail, aggressive gonorrhea strains could rage unchecked through the human populations in which they first evolve before undoubtedly spreading elsewhere.

To circumvent a possible pandemic, new classes of antibiotics are desperately needed. However, the process to take a drug from discovery through pre-human testing, human clinical trials, and finally market approval, typically requires 10 or more years and billions of dollars. 

In the meantime, curbing the out-of-control overprescription of antibiotics and banning the dangerous practice of feeding large quantities to livestock will be essential to keeping our bodies, naughty bits included, free from infection.