Antibiotic resistant gonorrhea is a growing problem around the globe. There are very few antibiotics that are still considered to be reasonably effective against the bacteria, and they are losing efficacy over time. There is a reasonable possibility that we could end up with untreatable strains within my lifetime, and most of the research that gets published contains bad news.

That tends to make me a bit gloomy when discussing the topic, which is why it was nice to see the paper that was recently published online by a group of British sciences in Lancet Infectious Diseases. The study, which looked at antibiotic resistance patterns in England and Wales, found something quite interesting. The standard operating procedure for dealing with antibiotic resistance is to stop using an antibiotic as first-line therapy as soon as resistance is seen in 5 percent of cases. As such, the countries stopped using cefiximine in 2010. However, when they did, something interesting happened. The prevalence of cefiximine resistant gonorrhea isolates dropped from 17 percent to 11 percent over the course of a year.

That result is somewhat contrary to expectation, but it's potentially very good news. If confirmed, it suggests that it may be possible to bring some of the older antibiotics back into rotation for gonorrhea treatment - either alone or in combination. There's a possibility that if doctors do so, resistance may develop faster next time, but some of that risk may be reduced using multi-drug therapies. It's not a solution to the antibiotic-resistant gonorrhea problem, but it might mean we have a little more time.

• The Problem of Antibiotic Resistant Gonorrhea

Over the weekend, I had a brief, if fascinating, conversation with a fake cure hocker* on Twitter. It looked like this:

I didn't hear back from them again after I asked for peer reviewed research. However, given the tweet that originated the conversation, I feel as though I am within my rights to hammer one point home...

Any company promising you a herpes cure is lying to you and trying to take your money. There is no scientific evidence that any herpes cure exists. There are medications that can reduce outbreaks and transmission risk, and natural remedies that may help with symptoms, but they aren't cures. Drugs also aren't guaranteed to work for everyone infected with a herpes viral infection-- not even the drugs you get from your doctor. An honest company marketing a herpes treatment isn't going to offer you anything more than a reasonable chance of reducing outbreak severity, frequency, and length.

There's no question that it would be wonderful if someone invented a cure for herpes. If someone did, and it worked, it would be all over every relevant scientific journal and newspaper. Doctors and scientists would be singing its praises from the rooftops. However, before you are willing to believe something is a cure, you should be able to see real evidence supporting it, evidence published in a quality, peer-reviewed source. Testimonials tell you nothing about whether or not a particular treatment will work for anyone else. They don't even prove that the treatment worked for the people raving about it.

• Identifying Treatment Hoaxes
• Why Fake Treatments Might Still Make You Feel Better

*_{Were they to provide me with research-based evidence, I might be convinced that this product could affect outbreak frequency (although the efficacy of lysine is questionable.) However, the name on the twitter account and much of their website text (screen capture available) implies that they are marketing their product as a cure. That is something it is not.}

Normally, when I talk about Canada, I'm talking about something awesome that Canadians have managed to accomplish in the sexual health arena. Not this time. This time, I get to report the somewhat distressing news that Vancouver, British Columbia seems to be in the midst of a bit of a syphilis epidemic. They had more diagnoses last year than had been seen in three decades. Risk seems to be particularly high in men who have sex with men, something which has also been seen in other communities. In part this is because oral sex is seen as a relatively low risk activity by many MSM, which it is for HIV but not for syphilis.

The good thing about syphilis is that it's easy to test for and treat. The bad thing about syphilis is that, left untreated, it can lead to significant long term health problems. It's also a particularly risky infection for pregnant women to contract. Congenital syphilis, although rare in recent years, can be fatal.

• Syphilis and Oral Sex

In my not so humble opinion, the law shouldn't be doing anything to make transactional sex any more dangerous than it already is. No matter what you think about the legality of commercial sex work, it exists, and it is in the public's interest to help people who engage in it to do so as safely as possible. Making it legally risky for people, particularly sex workers, to carry condoms only hurts the people that the law is theoretically intended to help. Condoms don't hurt people, and they don't cause people to have sex. They just make the sex a person was already planning to have less likely to hurt them later.

• Do You Have a Condom?