The Fight Against Antibiotic-Resistant Gonorrhea is Not Over Yet

The global increase in antibiotic-resistant gonorrhea is alarming due to the fact that there are only a few recommended options left to treat the condition. A main concern is that gonorrhea is becoming more resistant to the antibiotic, cephalosporin.

Gonorrhea is transmitted through vaginal, oral, and anal intercourse and predominantly found in teens and young adults ranging from 15 to 24 years of age. The symptoms of gonorrhea can manifest in many different ways. Men can experience symptoms, such as burning when urinating, painful or swollen testicles, or white yellow, or green discharge. Women may experience burning when urinating, increased discharge, or bleeding between periods.

Despite these uncomfortable symptoms, the most dangerous instance might be experiencing nothing at all. When there are no visible signs available, it is harder for the individual to discover they have it, thus increasing the chances of spreading the infection to others. Women are more likely to experience no symptoms than men. Women have a 50% chance of experiencing either mild or no symptoms, while men have a 10% chance of this occurrence.

Officials in the United States, Japan, France, Spain, and England have reported cases of antibiotic-resistant gonorrhea.

The spread of an antibiotic-resistant gonorrhea is cause for global concern, especially in countries that cannot afford to implement the latest recommended treatments which are designed to minimize resistance to the drugs.

In the 1990s, three antibiotic treatments were available: ciprofloxacin (a fluoroquinolone), ceftriaxone, and cefixime (both are types of cephalosporin). By the late 1990s and early 2000s, the first detections of ciprofloxacin-resistant gonorrhea were found in the United States, along the West Coast and in Hawaii. In 2004, ciprofloxacin-resistance was found in homosexual men. Two years later, cases of ciprofloxacin-resistant gonorrhea increased to 13.8% and were found in all areas of the United States, in heterosexual men and women. Ciprofloxacin fell out of use in 2007 when 15% of cases reported drug resistance. Today, only the two types of cephalosporin are left, ceftriaxone, and cefixime.

In a small timeframe, antibiotic-resistant gonorrhea was able to spread fast and disable the susceptibility of the recommended treatment. Over time, a more antibiotic-resistant gonorrhea will spread, causing the efficacy of the current treatment to decrease. Cephalosporin resistance means there would be no way to treat it until a new treatment is found.

The Centers for Disease Control and Prevention (CDC) previously relied on the cefixime type of cephalosporin, but its effectiveness has been declining. A combination ceftriaxone, along with supplementary antibiotics, azithromycin or doxycycline was the CDC go-to, in 2012. The current treatment for gonorrhea — an injectable ceftriaxone and an oral azithromycin – was put into place with hopes that it would mitigate the chances of infection becoming resistant to cephalosporin.

The World Health Organization (WHO) has been working to monitor trends and enact a global response for gonorrhea. WHO’s global, Gonococcal Antimicrobial Surveillance Programme, was revamped in 2009 to coordinate with an international collection of laboratories to monitor trends, establish testing, educate public health authorities, detect any increase of resistance, and check for failures of the recommended treatment.

In a long-term global perspective, antimicrobial monotherapy, or using new antimicrobials in a dual antimicrobial therapy may deem effective. The options being discussed are antimicrobials, such as amino glycoside gentamicin, solithromycin, ertapenem, and tigecycline.

Gentamicin has been used In Malawi in vitro without any reported resistance. However, there is no data on gentamicin’s effectiveness for a pharyngeal or anorectal gonorrhea. Solithromycin is also effective in vitro and can be absorbed orally, but would not work well in antimicrobial therapy. Tigecycline is similar, effective in vitro, but has not been tested against antibiotic-resistant gonorrhea.

The prospects of creating a gonococcal vaccine are improving. There have been developments made in understanding the process of the infection by:

• Using experimental infection in male volunteers
• Learning more about the development of polyvalent vaccines
• Identifying the genome sequence of vaccine candidate antigens

However, the search to create a vaccine is complicated due to the difficult characteristics of a gonococcal infection. There are no current vaccines in the works, but a vaccine that could eliminate some of the more severe complications of gonorrhea without fully preventing the infection would still help those suffering, and further research.

Individuals should practice safe sex and always use a condom. Those who have been treated for gonorrhea in the past are still in danger of getting the infection; again, vigilant safe sex measures are advised.