STDs are bad. Antibiotic-resistant STDs are worse.
This September marked the announcement of the first known case cluster of increased antibiotic resistance in sexually transmitted infections in the US. While seven gonorrhea patients in Hawaii were all eventually treated and cured by the antibiotic mixture of ceftriaxone and azithromycin, as recommended by the Centers for Disease Control and Prevention, their infections were not treated as quickly and easily as they should have been.
Researchers that reported on the cluster at the CDC's 2016 STD Prevention Conference estimated that 800,000 Americans a year could potentially contract untreatable gonorrhea if the disease continued its resistance. According to the World Health Organization, out of all STIs, gonorrhea has developed the strongest resistance to antibiotics—though antibiotic resistance in chlamydia and syphilis also exists—and strains of this multidrug-resistant gonorrhea have been detected worldwide. Untreated gonorrhea can result in serious long-term health problems such as pelvic inflammatory disease and infertility.
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WHO medical expert Dr. Teodora Wi tells Broadly that strains of gonorrhea can develop many mechanisms of resistance. "The bacteria can inactivate [treatment] drugs, they can also alter some parts of their microbiological make-up so that the drug becomes ineffective," Wi says. "They also can increase the cell wall to prevent the antibiotic to enter."
In other words, she says, "they're smart."
In light of this, WHO has enhanced surveillance of gonorrhea and its drug resistance. "What's happening now is that we have about 50 to 60 countries reporting to an antimicrobial surveillance program," Wi says. "And in a majority of these countries, there is a high risk of resistance." It has already led the WHO to update its international recommendations for STI treatment.
As STI rates rise, it's imperative for public policymakers to understand and communicate what exactly is going on. In Rhode Island from 2013 to 2014, rates of syphilis infections increased by 79 percent while gonorrhea cases increased by 30 percent. The Rhode Island Department of Health attributed these rates to high-risk behaviors like "having sex without a condom" and "having multiple sex partners" as well as "using social media to arrange casual and often anonymous sexual encounters."
It's not just the state of Rhode Island placing blame on dating apps for an increase in reported STI infections. The British Association for Sexual Health and HIV warned that dating apps used for casual sex have the potential to start an "explosion of HIV" in heterosexual populations. The US arm of the AIDS Healthcare Foundation went as far as to pay for billboards directly linking Tinder and Grindr to gonorrhea and chlamydia.
While a study conducted in 2014 showed that gay men meeting on dating apps "are at greater risk for gonorrhea and chlamydia" than men who meet in person, most of the arguments linking STI rates and apps are still anecdotal.
With dating apps you are meeting people that you aren't familiar with, which can result in riskier behavior such as not using a condom
Wi explains it as simply a matter of risk. "With dating apps you are meeting people that you aren't familiar with, which can result in riskier behavior such as not using a condom," she says. And with that multiplied risk, Wi explains, "it's more likely that you might acquire an STI."
But let's face it: Dating apps aren't going anywhere anytime soon. Instead of villainizing them, Tom Bertrand, chief of the Office of HIV/AIDS, Viral Hepatitis, STDs and Tuberculosis at the Rhode Island Department of Health, told WBUR radio that his clinic staff now works with patients to use their apps to alert partners of possible infection.
Apps to help with the prevention of STIs include Mately, a monthly subscription service that tests users for STIs and allows them to share results with potential hookups. And earlier this year, Tinder added a new feature that helps users find local STI testing through a new health safety section on its website.
At the same time, apps are certainly not the only issue at hand. Condom usage in teens has stalled at around 60 percent over the past decade, and while teenagers are more likely to use a condom for their first sexual encounter, condom usage dips off after that first time.
When teens are just starting to learn about sexual health, "the message that adolescents focus in on is preventing pregnancy," says Wi. "The perception of the risk for an STI is much lower. But adolescents are not only at risk for pregnancy but also at risk for STIs."
During the AIDS epidemic, condom-usage rates perked up, according to Wi. "People were so scared of HIV, it also had an impact on different STIs," Wi says. "You saw gonorrhea, syphilis, all the other STI rates come down." Now people have become complacent, she explains. "That's when you start to see this rise in STIs."
So what's next? Wi says there needs to be "a global STI strategy" in order to ensure adequate treatment for people who have STIs and conduct screening for asymptomatic people. Prevention, however, remains the central tenet. "The main issue is we need to prevent people from ever getting sexually transmitted infections," Wi says. "To prevent resistance, you do it by using condoms."