An often-overlooked type of STD, oral gonorrhea presents a challenge for healthcare in Thailand and globally. The threat this bacterial infection poses is not limited to the disease itself – there are large-scale public health issues related both to long-term inflammation by an infection in the throat or mouth left untreated and to the wrongful prescription of certain antibiotics that give rise to so-called “super-strains” of bacteria that cannot be combated with conventional antibiotics. Awareness campaigns, proper diagnosis by healthcare providers, and appropriate treatment can help combat this illness.
Oral gonorrhea is a particular concern for Thailand because of the high numbers of M2M (male-to-male) sexual encounters relative to neighboring countries. Many members of this community, more so than in the Thai population at large, mistakenly believe engaging in oral sex poses little or no risk to participants – or, that if there are risks, they are negligible and easily detected. This is not the case with oral gonorrhea. The higher rates of promiscuity among the M2M populations compound dangers of the widely held myth in the safety of oral sex, rendering this group at a much higher risk of infection.
Indeed, the National Institutes of Health, in a 2017 study
, found that oral gonorrhea in particular disproportionately affects the M2M community because of the types of sexual activities this group engages in:
“The rate of gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of gonorrhea prevalence in men who have sex with men.”
The Importance of Identifying and Diagnosing Oral Gonorrhea
While gonorrhea infections located on or around the genitals or anus often come with tell-tale symptoms like itching, burning, and painful urination, infections of the mouth and throat are almost never accompanied by symptoms.
Due to the nearly complete lack of symptoms in most cases, the biggest obstacle to diagnosing oral gonorrhea is the first step of ordering the test. Especially in public clinics where resources are scarce, doctors
will typically only perform diagnostic tests for STD infections when there is a compelling reason to do so – i.e., symptoms that might raise a red flag.
For this reason, health advocacy groups like US Centers for Disease Control and the World Health Organization recommend regular gonorrhea testing of all sexually active individuals regardless of the presence of symptoms. A thorough screening of as many members of a given population as possible can help greatly reduce STD transmission rates.
Testing for oral gonorrhea, relative to other diagnostic procedures, is relatively inexpensive. A swab test will indicate the presence of any infection.
If there is a positive result, the healthcare provider will then move on to treatment. Previously, treatment of gonorrhea (oral and other varieties) was the straightforward administration of an antibiotic cocktail, typically including Azithromycin and Ceftriaxone. However, as explored below, recent studies have discovered a waning effectiveness of these drugs for the treatment of gonorrhea as well as wider public health implications.
Misdiagnosis of Oral Gonorrhea: Complications
Oral gonorrhea is often misdiagnosed in Thailand and abroad
. When such an error occurs, health providers may treat the patient for strep throat or some other infection. The wrong antibiotics are then administered to the patient. Not only is this ineffective for treating the patient’s gonorrhea, but across space and time the wrongful administration of antibiotics can give rise to so-called “super-strains” – dangerous mutations of bacteria, including the variety responsible for oral gonorrhea, that are immune or resistant to antibiotics. As a consequence, the conventional antibiotics that previously successfully treated infections of these bacteria no longer work. Without appropriate measures, a public health crisis can ensue.
In addition to antibiotics designed to treat other infections that are incorrectly utilized in misdiagnosed cases of gonorrhea, there is a related problem – resistance of antibiotics indicated for gonorrhea treatment due to their overuse and ensuing genetic evolution of the bacteria. The ubiquitous application of certain antibiotics like Azithromycin and Ceftriaxone has rendered them ineffective in a growing number of gonorrhea cases, startling researchers who ponder the consequences. The National Institutes of Health concluded in a study
“…a growing body of evidence suggests that azithromycin is becoming less effective and should not be used as a monotherapeutic agent for gonorrhea… the effectiveness of current treatment options will be challenged. It is critical that countries expand systematic surveillance for drug-resistant N. gonorrhoeae and that laboratories maintain culture capacity to support rapid response activities to confirm suspected treatment failures.”
According to a report
from the World Health Organization, “Gonorrhoea is on a growing list of infections that may soon become untreatable.” The researchers go on to identify Thailand as being in a unique position to address this problem:
“Thailand is a pathfinder for providing non-discriminatory health services and addressing gonorrhoea. Because they are working hard at reaching people who have gonorrhoea, they are also in an ideal position to improve surveillance – tracking how many people have the illness, obtaining some demographic information and accurately assessing what treatment they need.”
Systemic Inflammation from Gonorrhea and Associated Risks
As of now, there have been no studies confirming a direct link between untreated oral gonorrhea and more serious illnesses like neck cancer or even lymphatic cancers. However, there is reason to be concerned.
Oral gonorrhea causes inflammation of the sinuses, throat, and mouth. The medical community has long recognized the potential for long-term inflammation, even low-grade inflammation, to damage DNA and aid in the metastasization of cancerous growths. Recent research has increasingly explored this link, and the mechanisms through which inflammation precipitates the spread of cancer. As the National Institutes of Health notes in a study
, “Recent data have expanded the concept that inflammation is a critical component of tumour progression. Many cancers arise from sites of infection, chronic irritation and inflammation.”
Public policy crafters in Thailand and elsewhere would be wise to take the threat posed by oral gonorrhea seriously. More study is needed to survey new ways to diagnose, treat, and ultimately prevent this potentially devastating STD to avoid large-scale negative consequences.
Thailand Medical News hopes that this article will generate more awareness and need for authorities in Thailand Healthcare Industry and also physicians to pay more attention to this growing threat and also for medical researchers to also study the possibility of correlations between oral gonorrhea and the rise of neck and throat cancers, new eye infections with particularly unexplaiined sensitivities to light and other diseases.