Authors: Martha Powell, Future Science Group
The WHO has warned of the spread of drug-resistant gonorrhoea, some strains of which may be untreatable with all known antibiotics. Data from 77 countries has highlighted antibiotic resistance in gonorrhoea is making this sexually-transmitted infection more challenging, and sometimes impossible to treat.
Medical Officer of Human Reproduction at WHO, Teodora Wi, explained: “The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”
It is estimated that 78 million individuals are infected with gonorrhoea each year. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), recently published data from 2009–2014 reporting widespread resistance to drugs commonly used to treat this infection.
Out of the 77 countries that reported data during this period, 97% found strains resistant to ciprofloxacin, 81% reported increasing resistance to azithromycin, and 66% reported the emergence of resistance to the current last-resort treatment, the extended-spectrum cephalosporins (ESCs).
ESC resistance has now been documented in over 50 countries, prompting the WHO to issue updated treatment recommendations in 2016, advising combined antibiotic treatment of ceftriaxone (an ESC) and azithromycin.
Some countries have reported cases of the infection that are untreatable by all known antibiotics –specifically three cases from Japan, Spain and France where patients were infected with gonorrhoeal strains against which no treatment was effective.
Wi added: “These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common.”
Although gonorrhea can be prevented via safer sexual behavior, the WHO has stated that development of new drugs is necessary. Currently, the research and development pipeline is relatively empty, with only 3 candidate drugs.
Manica Balasegaram, Director of the Global Antibiotic Research and Development Partnership, commented: “To address the pressing need for new treatments for gonorrhoea, we urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline.”
“In the short term, we aim to accelerate the development and introduction of at least one of these pipeline drugs, and will evaluate the possible development of combination treatments for public health use. Any new treatment developed should be accessible to everyone who needs it, while ensuring it’s used appropriately, so that drug resistance is slowed as much as possible.”
Marc Sprenger, Director of Antimicrobial Resistance at WHO, concluded: “To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures. Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on that particular infection – and longer term, a vaccine to prevent gonorrhoea.”