Gonorrhea on the Path to Becoming Untreatable

New data recently released by the World Health Organization (WHO) are showing that one sexually-transmitted disease is progressively moving closer to becoming untreatable: gonorrhea.

This is not an idle threat. According to WHO, Neisseria gonorrhoeae, the bacteria responsible for the infection, are developing widespread resistance to the antibiotics currently used for treatment. This news not only underscores the need for new antibiotics, but also the need for new, affordable point-of-care diagnostic tests so that individuals can receive diagnosis quicker, and thus, timely treatment.

“The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them,” Dr. Teodora Wi, Medical Officer, Human Reproduction at WHO, explained in the recent news release.

WHO estimates that a staggering 78 million individuals are infected with gonorrhea on an annual basis, and the number of cases that are resistant to current available antibiotics continue to grow in number, according to the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP).

For example, according to GASP data, 97% of countries included in the dataset reported widespread resistance to ciprofloxacin between 2009 and 2014. WHO also noted an increased number of cases that were resistant to azithromycin (81%) during that period as well. However, arguably the most startling news is “the emergence of resistance to the current last-resort treatment,” or the extended-spectrum cephalosporins (ESCs), cefixime and ceftriaxone (66%). As of right now, ESCs are the last hope for treating gonorrhea in most countries; however, over 50 countries are reporting resistance to these drugs. In response to these data, WHO updated their treatment recommendations to indicate that doctors should prescribe 2 antibiotics to those who are infected with gonorrhea: azithromycin and an ESC: ceftriaxone.

In their news release, WHO postulated that there may be many factors that contributed to the increase in antibiotic-resistant infections. These include:

• A decrease in condom use
• An increase in urbanization and travel
• Poor infection detection rates
• Inadequate/failed treatment

Regardless of the reasons, the fact cannot be denied: the bacteria are well on its way to becoming untreatable if something is not done about it soon. Unfortunately, the outlook on the development of new antibiotics is not that promising. In fact, WHO reports that “the research and development pipeline for gonorrhea is relatively empty,” as there are only 3 drug candidates currently in development: solithromycin, zoliflodacin, and geptotidacin.

All hope is not lost, however. Working together with The Drugs for Neglected Diseases initiative, WHO is launching a nonprofit organization, Global Antibiotic Research and Development Partnership (GARDP) dedicated to developing new antibiotic treatments for gonnorhea and ensuring that those who need these treatments the most can get them. The organization will also focus on promoting correct antibiotic use, in order for the drugs to “remain effective for as long as possible.”

“To address the pressing need for new treatments for gonorrhea, we urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline,” Dr. Manica Balasegaram, GARDP Director, explained in the press release. “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.” She continued, “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.”

Gonorrhea can be prevented if individuals engage in safer sex practices. In fact, with more information, education, and communication, researchers hope that individuals will be able to identify associated symptoms and thus, receive the treatment that they need. The problem is, there are no rapid point-of-care diagnostic tests available for gonorrhea, and, often, those who are infected do not present with any telltale signs of infection; this means that they can remain untreated and develop serious complications.

To add to these issues, many times if an individual presents with symptoms that are similar to those associated with gonorrhea, many practitioners proactively treat them accordingly, even though they may not be infected with gonorrhea. This misdiagnosis, and unnecessary prescribing are also contributing factors to the growing resistance of the bacteria.

“To control gonorrhea, 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,” Dr. Marc Sprenger, Director of Antimicrobial Resistance at WHO commented in the news release. New antibiotics and diagnostic tools that are capable of predicting “which antibiotics will work on that particular infection” are needed in order to cut down on the alarming numbers, he concluded.