Gonorrhea is making a comeback and it is looking very much like its 1920s version: untreatable. 

Gonorrhea (or tulo in Tagalog and other street names like “drip” and “clap”) is a sexually transmitted infection that raged before the discovery of drugs to treat it. 

Earlier this month, the World Health Organization (WHO) reported a widespread resistance of gonorrhea to “older and cheaper antibiotics”. Data from 77 countries showed cases of gonorrhea that is “much harder, and sometimes impossible, to treat.” In some high-income countries where STI surveillance is particularly efficient, WHO reported cases of gonorrhea that are untreatable by all known antibiotics.

Globally, an estimated 78 million people are infected with gonorrhea every year.  

Gonorrhea is spread through vaginal, anal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can pass on the infection to her baby during childbirth.

Complications related to gonorrhea include increased risk for HIV and if left untreated, infertility.

‘Tulo’ in the Philippines

Infectious diseases doctor at the Philippine General Hospital Dr. Edsel Salvana says that if gonorrhea were a person, it would be a “really obnoxious person who doesn’t have a concept of personal space.”

“The bacteria itself is two bacteria stuck together inside a cell and is usually characterized by  pus coming out of your penis,” explained Salvana.

Salvana also explained that gonorrhea behaves differently in men and women. While most men will likely have a discharge coming out of their penis, which would trigger them to seek care almost immediately, most women may just experience increased vaginal discharge and not see it as anything beyond the usual.

“So while most men will seek care, women will have to either be informed by their partners, or regularly see their gynecologists for checkups. It is women who are the most vulnerable because they may harbor an STD from an unfaithful infected partner without knowing it,” said Salvana.

Data shared by the World Health Organization (WHO) in Manila shows that in 2016 more than 200,000 were tested for gonorrhea and more than 14,000 tested positive or a positivity rate of about 0.07% 

While these are indications, they do not give a full picture of gonorrhea in the Philippines because of gaps in data gathering.

“The numbers have more to do with how gonorrhea is tested and who gets tested. There is a huge rate of unreported gonorrhea,” said Dr. Gundo Weiler, WHO Philippines country representative.

Most of those tested are registered female sex workers who are tested regularly. Data shows that more women get tested while more men turn out positive for gonorrhea. 

Regular voluntary testing among the general public is scant, with prohibitive costs possibly being one of the main reasons why. The molecular DNA probe test, or the “gold standards” of tests remains very expensive.

Self-medicating

Growing resistance to anti-biotics is the main reason why gonorrhea is making a comeback worldwide. Here in the Philippines, doctors say that resistance to usual drugs used to treat gonorrhea like penicillins is still within acceptable levels. 

“We still have treatment options available in the country, but that is no reason to think that we are going to escape the gonorrhea epidemic,” warned Weiler. “The increasing number of HIV infections point to low condom use and should serve as a wake up call to practice safer sex.”

Additionally, we should be more conscious about using anti-biotics. Salvana and Weiler both have the same advice: “Don’t self-medicate.”

“The haphazard use of antibiotics for non-bacterial illnesses such as colds and upper respiratory infections due to viruses has immensely contributed to the rise of drug-resistant gonorrhea. Let’s do our part in making our antibiotics work again by not pressuring our doctors to give us antibiotics if we don’t need them, and only taking antibiotics if properly prescribed by a physician,” advised Salvana. – Rappler.com

Ana P. Santos is Rappler’s sex and gender columnist and a Pulitzer Center grantee. In 2014, the Pulitzer Center on Crisis Reporting awarded her the Persephone Miel fellowship to do a series of reports on Filipino migrant mothers in Dubai and Paris.