You want 2021 to be super. But not in a super gonorrhea type of way.

“Super gonorrhea” is trending on Twitter right now because, well, why not? It’s 2020, after all. And what better thing to have trend at the end of a year that brought us the Covid-19 coronavirus pandemic, a shortage of basically everything, constant drama in the White House, and a Presidential election that just won’t end? Consider this sexually transmitted infection to be the pie à la mode, the night cap, the final wipe of 2020.

If you haven’t figured it out yet, super gonorrhea is not super to have. It won’t prompt you to tell your partner, “I just returned from the doctor’s office, and I’ve got super news for you.” Nah, telling him or her that you have super gonorrhea would be about as positive as saying that you have sexy syphilis or candy-coated chlamydia. Super gonorrhea isn’t a comic book hero either, in case you are wondering:

If it were featured in a film, super gonorrhea would give Ghost Rider a run for worst comic book movie ever.

Instead, super gonorrhea results when the bacteria that causes gonorrhea, Neisseria gonorrhoeae, develops a high level of resistance to the antibiotics normally used to treat the infection: azithromycin and ceftriaxone. As I reported back in 2017 for Forbes, the World Health Organization (WHO) listed such strains of N. gonorrhoeae on its world’s most dangerous superbugs list. When making your bucket list, don’t include anything on this WHO superbug list. “We’ve run out of ways to treat your infection,” ranks up there with “no one can fly the airplane” or “the hull of the cruise ship that you are on is made out of pickles” on the list of things that you don’t want to hear.

Then in 2018, I covered for Forbes a case of a man from the United Kingdom (U.K.) who had had a “super” sexual encounter while traveling in Southeast Asia. The man developed symptoms a month later and was diagnosed with super gonorrhea. As a result, the man’s regular partner in the U.K. had to get tested, but she fortunately tested negative for the superbug. It’s not clear whether this couple remained together after the super revelation. After all, things like not knowing how to tango or infecting you with super gonorrhea can be deal breakers for some when it comes to dating. If the relationship did continue, the woman would have had quite a card to raise in future arguments such as, “what you won’t take out the trash? Well, remember that time you had sex with someone else and almost gave me super gonorrhea?”

So why is super gonorrhea trending on Twitter when there are oh so many other things that can trend? Well, there are different possibilities:

But it looks like the trending stemmed from a WHO spokesperson telling The Sun that the overuse of azithromycin and the lack of services to treat sexually transmitted infections (STIs) during the Covid-19 coronavirus pandemic may be fueling the rise of super gonorrhea. Not the Sun as in that fiery ball in the sky that you shouldn’t look at even during an eclipse but The Sun as in the U.K. publication.

Indeed, use azithromycin more often can select for more resistant versions of N. gonorrhoeae. Remember earlier this year when some were touting the use azithromycin along with hydroxychloroquine to treat Covid-19? And some political leaders jumped on this bandwagon? This was even before well-constructed and executed clinical studies were done to assess the safety and efficacy of such medications for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections. So this was an example of premature medication. Since then clinical studies have not found enough evidence to support such use. In a commentary in The Lancet, Catherine E. Oldenburg, PhD, an Assistant Professor and Thuy Doan, MD, PhD, an Associate Professor at the University of California, San Francisco, (UCSF) concluded “for patients with Covid-19, the addition of azithromycin to existing standard of care regimens does not appear to improve outcomes,” after reviewing results from the COALITION II trial that evaluated adding azithromycin to hydroxychloroquine and standard of care to treat patients hospitalized with severe Covid-19.

As a result of the scientific evidence that has subsequently emerged, the National Institutes of Health (NIH) Covid-19 Treatment Guidelines Panel now “recommends against the use of chloroquine or hydroxychloroquine with or without azithromycin for the treatment of Covid-19” in hospitalized or non-hospitalized patients.

Pharmaceutical company in Saransk, Russia, produces medicine to treat COVID-19 patients

For everyone who may have said, “what’s the harm in continuing to use azithromycin to treat SARS-CoV2 infections,” well here’s a super response. Using antibiotics indiscriminately on infectious diseases as if the medications were Nutella can encourage the growth of resistant organisms. Antibiotics like azithromycin are considered “broad spectrum” because they can kill or inactivate a wide range of different bacteria. It’s like using a bomb rather than a rifle. That can be helpful when you don’t know what is causing an infection or when there is no other option.

However, every time you use a broad spectrum antibiotic rather than a treatment that’s a lot more targeted and specific, you risk wiping out friendlier bacteria and weaker versions of a pathogen like N. gonorrhoeae, leaving stronger more resistant versions a more open field to flourish. The remaining stronger ones then multiply and become a lot more predominant. This is how more resistant versions of the bacteria take over and spread.

In the U.S., the five years from 2013 to 2018 saw an over sevenfold jump in the percentage of N. gonorrhoeae samples that are less susceptible to azithromycin from 0.6% to 4.6%. The rise of azithromycin resistance in N. gonorrhoeae has prompted a December 18 change in the Centers for Disease Control and Prevention (CDC) guidelines for treating uncomplicated gonorrhea. Rather than a two-drug azithromycin and ceftriaxone approach, the CDC is now recommending just one 500 mg injection of ceftriaxone. By “uncomplicated,” the CDC means your run-of-the-mill gonorrhea infections of number one your urinary tract, number two your rectum, your genital areas, or your throat. If you don’t know how each of these places can be affected by N. gonorrhoeae, you may need to re-take sex ed. Of course, more complicated gonorrhea may require antibiotics.

One problem with the Covid-19 coronavirus pandemic is that other pathogens haven’t necessarily taken a break. They haven’t spent most of their time on Zoom calls muting each other and using the video filters while saying, “hey look at me, herpes with a hat.” While humans social distancing may have limited the spread of some pathogens such as influenza, others may have had a good 2020.

Sexually transmitted disease clinic
The Covid-19 coronavirus pandemic has either closed or limited the efforts of clinics and other efforts that normally aim to reduce the spread of sexually transmitted infections. (Photo by Derek Davis/Portland Portland Press Herald via Getty Images) PORTLAND PRESS HERALD VIA GETTY IMAGES

After all, the pandemic has not only prompted doctors to try different antibiotics to treat Covid-19 coronavirus, it has also reduced the availability of doctors to properly treat STIs. The pandemic has shut down many “non-essential” health services or dissuaded many patients from seeking proper medical care. Therefore, people may be running around with untreated infections or trying to self-treat with potentially inappropriate antibiotics.

As I’ve said repeatedly, the Covid-19 coronavirus pandemic has been exposing many of the problems that have already existed in society. Antibiotic-resistant bacteria is one of them. If nothing is done to better tackle this looming problem, pathogens like super gonorrhea will be far from gone baby gone in 2021 and beyond.