How the EU is Combatting Drug-Resistant Gonorrhea

Antibiotic resistance is a term that invokes fear and worry across multiple sectors. When many people think of antimicrobial resistance (AMR) they commonly think of super infections in the lungs or bloodstream. Unfortunately, there is an all too real threat of AMR when it comes to sexually transmitted diseases (STD) like gonorrhea.

In the United States, there is a national surveillance program, which was established in 1986, and tracks antimicrobial susceptibility of Neisseria gonorrhoeae strains throughout STD clinics. A new report in 2017 found considerable trends in gonorrhea incidence, noting that it is the second most reported STD with roughly 820,000 cases each year.

Abroad, multi- and extensively drug-resistant gonorrhea (MDR and XDR NG) poses a considerable problem. The European Centre for Disease Control (ECDC) has recently created a 2019 response plan to control and manage these varying levels of resistant gonorrhea throughout Europe. The report notes that “Over the past decades, N gonorrhoeae has developed AMR to several antimicrobial classes such as sulfonamides, penicillins, tetracyclines, macrolides, fluoroquinolones and more recently third- generation cephalosporins. The first treatment failures connected to less potent oral third-generation cephalosporins were reported in Japan in 2000. Subsequently, further cases of treatment failure were reported from other Asian countries. A report from Norway described the first two treatment failures with cefixime in the European Union/European Economic Area, which were followed by treatment failures in England, Austria, France, Canada and South Africa”.

The World Health Organization has a Global Action Plan, which the ECDC’s 2012 Response Plan complements. In this latest report, the ECDC reviewed not only the 2012 plan, but also evaluated it, noting that the majority of countries have national gonococcal antimicrobial surveillance programs (82%) and an STD clinic network (86%). However, there were considerable gaps though in having communication plans and fact sheets. Additionally, 50% or fewer of countries reported that they have reviewed clinical management guidelines or have a platform for reporting treatment failures, let alone case definitions that have been agreed upon for treatment failure.

The 2019 response plan focuses on several key components, like strengthening surveillance of gonococcal antimicrobial susceptibility to help obtain AMR profiles in timely manners and provide sufficient epidemiological information. Other components include implementing “suitable treatment failure monitoring procedures to inform national and international authorities so that targeted intervention strategies can be implemented to prevent the spread of MDR and XDR N gonorrhoeae and effectively disseminate results from AMR surveillance in order to increase awareness and inform authorities, professional societies, clinicians and other health care workers and persons at risk about threat of MDR and XDR N gonorrhoeae.”

The plan heavily emphasizes that efforts need to be part of a comprehensive strategy that includes appropriate treatment, diagnostics and testing algorithms (i.e. 3-site testing in men who have sex with me), test of cure, notification and treatment of partners, enhanced focus efforts on those susceptive groups due to risk, and really advocating for condom use. The report also presented the working case definition for confirmed and possible treatment failure for both laboratory and clinical criteria.

Overall, the new ECDC approach to combatting multi- and extensively drug-resistant gonorrhea is comprehensive and made considerable effort to address the 2012 plan’s shortcomings. Combatting resistant gonorrhea will require long-term efforts that are evaluated frequently, but the ECDC has shown through the 2019 report, they have every intention of fighting the resistant infection with considerable force.