In a news release, the World Health Organization (WHO) has stated that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat.

Background Information:

Gonorrhoea is a sexually transmitted disease that can infect the genitals, rectum, and throat.

Complications of gonorrhoea disproportionately affect women, including

• pelvic inflammatory disease,
• ectopic pregnancy,
• infertility, and
• an increased risk of HIV.

There are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea.

Many people who are infected with gonorrhoea do not have any symptoms, so they go undiagnosed and untreated. On the other hand, however, when patients do have symptoms, such as discharge from the urethra or the vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even though people may be suffering from another kind of infection.

The overall inappropriate use of antibiotics increases the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases.

Key Messages:

Each year, an estimated 78 million people are infected with gonorrhoea:

• WHO Western Pacific Region: 35.2 million people,
• WHO South-East Asian Region: 11.4 million people,
• WHO African Region: 11.4 million,
• WHO Region of the Americas: 11.0 million,
• WHO European Region: 4.7 million, and
• WHO Eastern Mediterranean Region: 4.5 million.

This increase is due to

• decreasing condom use,
• increased urbanization and travel,
• poor infection detection rates, and
• inadequate or failed treatment.

Monitoring Drug resistance

The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in drug-resistant gonorrhoea. WHO GASP data from 2009 to 2014 find

• widespread resistance to ciprofloxacin [97% of countries that reported data in that period found drug-resistant strains],
• increasing resistance to azithromycin [81%], and
• the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone [66%].

Currently, in most countries, ESCs are the only single antibiotic that remain effective for treating gonorrhoea. But resistance to cefixime – and more rarely to ceftriaxone – has now been reported in more than 50 countries. As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give 2 antibiotics: ceftriaxone and azithromycin.

Development of new drugs

The development of new antibiotics is not very attractive for commercial pharmaceutical companies as

1. treatments are taken only for short periods of time (unlike medicines for chronic diseases) and
2. they become less effective as resistance develops,

meaning that the supply of new drugs constantly needs to be replenished.

There are only 3 new candidate drugs in various stages of clinical development:

• solithromycin, for which a phase III trial has recently been completed;
• zoliflodacin, which has completed a phase II trial; and
• gepotidacin, which has also completed a phase II trial.

Gonorrhoea prevention

Gonorrhoea can be prevented through safer sexual behaviour, in particular consistent and correct condom use.

Useful Links:

Link to the WHO news release:

http://who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/

Link to PLOS article on Multi-Drug Resistant Gonorrhoea (English) [PDF]:

Click to access Alirol_PLOS_multidrug-resistant_gonorrhea_2017.pdf

Link to WHO guidelines for the treatment of Neisseria gonorrhoeae (English) [PDF] (2016):

Click to access 9789241549691-eng.pdf

Link to WHO’s Global Action Plan on Antimicrobial Resistance:

http://who.int/antimicrobial-resistance/global-action-plan/en/