Hulu’s The Handmaid’s Tale adapts Margaret Atwood’s novel of the same name and imagines a nightmarish, dystopian United States where a superior class of women rely on handmaids, or women who are ritualistically raped to bear children for wives of leaders, who follow through with bizarre, fake pregnancies of their own. That’s because of a vague, never-explained global pandemic perhaps brought on by environmental changes. (Elisabeth Moss’s character, Offred, is one of these handmaids.)

Could a global pandemic make female fertility a rarity? It’s hard to imagine a world like this, but a few medical professionals and researchers Inverse reached out to suggested that such a dystopian reproductive future is [*insert sigh of relief*] probably not going to happen.

That statement, however, is tempered by the reality that STDs like syphilis and gonorrhea are scarily morphing faster than antibiotic technology can be developed, earning the frightening moniker of “superbug” because of their seeming ability to withstand and resist antibiotics.

The Center for Disease Control has sat up and taken notice. In an official statement on April 3, the CDC emphasized that while syphilis “was nearly eliminated a decade ago,” it’s making a vicious comeback — so much so that the agency declared April STD Awareness Month.

While experts don’t believe syphilis will create a widespread incidence of female sterility, it’s got the potential to be destructive. If untreated, there’s up to an 80 percent chance a pregnant woman will pass the disease on to her unborn child, causing congenital syphilis. That’s if the baby is born, though — if a pregnant woman displays signs of syphilis, there’s up to a 40 percent chance that pregnancy could end in miscarriage or stillbirth, the CDC warns. Those who make it to birth face a rough future: “brain damage, blindness, deafness, bone deformities, liver and spleen problems, and skin disease.”

Offred is a rarity in 'The Handmaid's Tale,' valued for her viable reproductive system after an STD pandemic makes most women sterile.
Offred is a rarity in 'The Handmaid's Tale,' valued for her viable reproductive system after an STD pandemic makes most women sterile.

It’s a pretty disturbing set of effects, despite the fact that 98 percent of congenital syphilis can be prevented. It might explain why, in Episode 2, we see Offred acting curiously distant about her pregnancy when she tells her best friend, Moira, about her pregnancy, then shrugs it off, saying that it would probably not go to term, anyways. In this alternate (?) dystopia, Offred might just be being practical, given what seems to be limited medical care and the fact that the odds are stacked against her.

But syphilis — as frightening as it is — might just be the tip of the proverbial STD iceberg, particularly because medical advances have made congenital syphilis one we can potentially inhibit ahead of time. The more likely diseases that are currently leading to infertility among women are gonorrhea and chlamydia, Brian Katzowitz of the Health Communication Science Office at the CDC, tells Inverse over email. “We don’t have a lot of data on how often STDs can lead to infertility, but it’s estimated that undiagnosed STDs cause infertility in more than 20,000 women each year.”

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Antibiotic resistance isn't new, but it's getting harder to fight STDs as they become increasingly powerful.
Antibiotic resistance isn't new, but it's getting harder to fight STDs as they become increasingly powerful.

Drug-resistant gonorrhea is what is increasingly worrying the CDC, with cases on the rise. In a recent fact sheet, the CDC discusses how gonorrhea hit peak infection levels around 1976, coinciding with the Baby Boomer generation coming of age, women’s liberation, and the free love movement, according to Discover; up to then, syphilis and gonorrhea were thought to be products of prostitution and “good time girls.” But it turns out that women across all socioeconomic levels wanted a good time, with pre-marital sex levels skyrocketing 300 percent; gonorrhea and syphilis levels followed suit. Experts aren’t sure what exactly led to the drop off in gonorrhea levels afterward — some have pointed to increased usage of condoms, others say Baby Boomers started aging and maturing and marrying off — but gonorrhea infection rates nosedived to its lowest levels within a couple decades.

Gonorrhea rates are worrisomely spiking back up in the United States.
Gonorrhea rates are worrisomely spiking back up in the United States.

Which makes the latest spike in gonorrhea strangely, scarily Handmaid’s Tale-esque. The CDC has carefully followed the disease since 1986, collecting thousands of samples of Neisseria gonorrhoeae to catalog and record, and have noticed a disturbing rise in not just gonorrhea cases but cases of gonorrhea that aren’t treatable by antibiotics. Part of this is a reflection of a need for more STD testing centers, but a lot of this is thanks to gonorrhea’s radical morphing into a “superbug,” or a bug that has somehow developed a resistance to antibiotics, whether it be from poor prescription practices or these bugs mutating faster than we can fight them. As Timothy Walsh, an immunity expert at Cardiff University told Inverse back in 2015, drug regulations and testing inherently create a timegap that favors these microbial bad guys and allows them to continue getting stronger.

In 2016, a review study offered a dark forecast: By 2050, 10 million people per year could die annually from superbugs. Of those superbugs, one of the most dangerous emerging ones is gonorrhea.

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And therein is why experts are worried. It takes years for drugs to be developed, tested, and put out to the general public. Gonorrhea — and other STDs — all could effectively shape the fate of our generation and beyond, and we aren’t sure how. Could it lead to something that’s as dire as The Handmaid Tale’s Gilead? Or could it simply lead to an epidemic? We’re not quite sure — and that’s what makes a superbug like the one gonorrhea is slowly becoming frightening.

Photos via Hulu, Center for Disease Control

Tanya Basu is the Science editor at Inverse. Her writing focuses on the social sciences and behavior. Now based in Brooklyn, she will always call Chicago home and never be too full for one more taco.