WHO issues warning about rise of drug-resistant gonorrhoea

Behind the Headlines

Friday July 7 2017

Gonorrhoea can go unnoticed and untreated, which can lead to serious complications

Gonorrhoea is passed on through unprotected vaginal, oral or anal sex

"Gonorrhoea fast becoming 'untreatable', WHO experts warn," reports Sky News.

Analysis of data from 77 countries by the World Health Organization (WHO) found antibiotic resistance exists against almost all antibiotics currently used to treat the sexually transmitted infection (STI) gonorrhoea.

In the past, gonorrhoea infections were treated effectively with a one-off dose of antibiotics.

Nowadays, gonorrhoea needs to be treated with both an antibiotic injection and a dose of antibiotic tablets.

And increased resistance to antibiotics, coupled with a lack of new treatments in the pipeline, raises concerns that the infection could be untreatable in the future.

This is concerning, as untreated gonorrhoea in women can cause complications that can lead to infertility and miscarriage. 

In this study, a WHO group outlined a new strategy to support the research and development of new treatments for gonorrhoea. Preventing the spread of the STI is also of paramount importance.

What is gonorrhoea?

Gonorrhoea is the second most common STI in the UK.

It's caused by the bacteria Neisseria gonorrhoeae, and can be transmitted easily through unprotected vaginal, oral or anal sex, infecting the genitals, back passage, and sometimes the eyes or throat.

Usual symptoms include an abnormal discharge from the vagina or penis, pain when passing urine, and bleeding in between periods in women.

Treatment involves an antibiotic injection and a single dose of antibiotic tablets.

But many people get no symptoms, so gonorrhoea can go unnoticed and untreated, which can lead to serious complications.

Around 10-20% of women can get pelvic inflammatory disease from gonorrhoea, which can then affect their fertility.

Gonorrhoea in pregnancy can also be transmitted to the infant, which can lead to newborn conjunctivitis and even threaten a baby's eyesight.

Where did the study come from?

The study was produced by the WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), a group of researchers responsible for monitoring trends in drug-resistant gonorrhoea.

What is the new evidence?

The group analysed data from 77 countries, and found there is increasing resistance to all the drugs currently used to treat gonorrhoea – to both the first-choice antibiotic, and to the second-choice antibiotic used when the first one fails.

Bacteria have the ability to respond and adapt to antibiotics, with the potential to become effectively immune to the antibiotic's effects.

Even more worryingly, they can develop resistance to many different antibiotics, which now seems to be the case for the bacteria that causes gonorrhoea.

There also aren't many drugs currently being developed for the treatment of gonorrhoea. This raises the concern that the spread of drug-resistant gonorrhoea could outpace the development of new drugs, and may even result in doctors not being able to treat the STI.

In order to address this, the Global Antibiotic Research and Development Partnership (GARDP) initiative was launched in 2016 by the World Health Organization and Drugs for Neglected Disease (DNDi).

GARDP is a not-for-profit research organisation that sets up programmes around the world that aim to develop short- and long-term treatments for STIs, among other things.

As part of their initiative to improve research and development for new treatments for gonorrhoea, GARDP convened a panel of international experts from various institutions in different regions, including India, South Africa and China.

Together, they have outlined a research and development strategy that could help target the development of new treatments for gonorrhoea.

Recommendations

GARDP seeks to work with various experts to bring one new treatment for gonorrhoea to the market by 2023.

This is discussed in the research and development strategy, which outlines four components.

  • component 1: accelerate the development of a new chemical entity
  • component 2: evaluate the potential of existing antibiotics and their combinations
  • component 3: explore co-packaging and development of fixed dose combinations
  • component 4: support the development of simplified treatment guidelines and foster conservation

Explained simply, this means that GARDP hopes to:

  • Accelerate the development and registration of new molecules and drugs for the treatment of gonorrhoea, particularly those in the later stages of clinical trials that may be close to entering the market.
  • Conduct further research through randomised controlled trials to test whether the drugs currently used have the ability to treat gonorrhoea effectively. The drugs will be tested in populations with high numbers of sexually transmitted infections, as well as countries known to have various forms of antibiotic resistance.
  • Explore the use of combinations of antibiotics in fixed doses, which will help reduce costs and hopefully lead to more people taking the drugs as prescribed.
  • Support the development of evidence-based guidelines to ensure any new treatments are globally accessible, but mainly to make sure they're used and prescribed in an appropriate manner to reduce the emergence of more antimicrobial resistance to the drugs – it would be counterproductive to produce a new antibiotic to which gonorrhoea then becomes resistant.

Conclusion

The increase in antimicrobial resistance towards drugs used to treat gonorrhoea is reaching a critical stage, especially given how common the infection is worldwide, with an estimated 78 million new cases in 2012.

This study raises concerns around an important topic while also proposing strategies to help address the slow pace of research and development of new drugs.

The prevention of gonorrhoea is equally, if not more, important. The most effective way to prevent gonorrhoea is to always use a condom during sex, including anal and oral sex.

Read more advice about sexually transmitted infections and how to prevent them.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

Gonorrhoea fast becoming 'untreatable', WHO experts warn. Sky News, July 7 2017

Oral sex spreading unstoppable bacteria. BBC News, July 7 2017

Gonorrhoea becoming 'untreatable', experts warn. ITV News, July 7 2017

Untreatable gonorrhoea 'superbug' spreading around world, WHO warns. The Guardian, July 7 2017

Links to the science

Global Antibiotics Research and Development Partnership. Multi-drug-resistant gonorrhoea: a research and development roadmap to discover new medicines. July 2017 (PDF, 230kb)

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