Untreatable strains of gonorrhoea are on the rise, the World Health Organization has warned, fuelling fears that last-resort drugs will soon be futile after three confirmed cases in which antibiotics were ineffective.
Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in the UK after chlamydia, with almost 35,000 cases reported in England in 2014. The WHO estimates that 78 million people worldwide contract the disease each year, with most cases affecting young men and women under the age of 25.
The latest warning is based on findings from two studies, co-authored by WHO researchers, looking at data from 77 countries; in more than 50, first-line antibiotics were ineffective.
“To control gonorrhoea, 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 failures,” said Marc Sprenger, director of antimicrobial resistance at the WHO. “Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on that particular infection – and longer term, a vaccine to prevent gonorrhoea.”
These concerns were echoed by others in the field.
“We are markedly concerned about the rise in antibiotic resistant gonorrhoea in the UK,” said Prof Claudia Estcourt, a member of the British Association for Sexual Health and HIV. “In a very short space of time, we have seen changes in the bacteria at an unprecedented rate, which means that many antibiotics which used to work are no longer effective. We are running out of options.”
As well as widespread resistance to first-line antibiotics for gonorrhea, resistance is increasing against second and third-line treatments, too.
Gonorrhoea spreads through unprotected vaginal, oral or anal sex, as well as through the sharing of sex toys that have not been washed properly or covered with a new condom. Many of those who contract the disease experience no symptoms, but if left untreated the disease can cause infertility and, in pregnant women, puts babies at risk of blindness.
Since the introduction of antibiotics in 1930s, the bacteria responsible for gonorrhoea, neisseria gonorrhoeae, has shown a remarkable ability to stay one step ahead of our most effective antibiotics.
“Gonorrhoea is a very smart bug,” said Teodora Wi, a human reproduction specialist at the Geneva-based UN health agency. “Every time you introduce a new type of antibiotic to treat it, this bug develops resistance to it.”
Wi said one of two new studies on gonorrhoea published in the journal Plos Medicine had documented antibiotic-resistant cases in Japan, France and Spain.
“These are cases that can infect others. It can be transmitted,” she told reporters. “And these cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common.”
Experts added that funding issues were adding to the problem.
“We are concerned that at a time of increasing drug-resistant gonorrhoea and limited treatment options, overall funding for sexual health services [in the UK] is being reduced, and a quarter of local authorities have had to reduce spending on sexual health services,” said Estcourt.
Manica Balasegaram, director of the Global Antibiotic Research and Development Partnership, said the situation was “grim” and there was a pressing need for new medicines.
The pipeline, however, is very thin, with only three potential new gonorrhoea drugs in development and no guarantee any will prove effective in final-stage trials, he said.
“We urgently need to seize the opportunities we have with existing drugs and candidates in the pipeline,” he said. “Any new treatment developed should be accessible to everyone who needs it, while ensuring it is used appropriately, so that drug resistance is slowed as much as possible.”
