A Drug-Resistant Form Of Gonorrhea Is Spreading Around The Globe

Various international health agencies have recently announced that more cases of drug-resistant gonorrhea have been popping up around the world. Gonorrhea is becoming more and more difficult to treat with current drugs, and some scientists are worried that the disease may become incurable with current drugs in the not-too-distant future.

Gonorrhea is one of the most common STDs in the world, ranking third in prevalence after chlamydia and HPV, although HPV is comparatively benign. Approximately half of all women who get the disease as well as 10% of infected men are asymptomatic, yet many others will experience pain while urinating combined with some unpleasant yellowish discharge. Untreated the condition can cause infertility in both sexes, along with pelvic inflammation in women.

New Cases Of Drug-Resistant Gonorrhea

The European Center for Disease Prevention and Control (ECDC) says that the past few months have seen a marked increase in reports of “extensively drug-resistant” gonorrhea in nations around the world. The ECDC reports that February and March of this year saw at least three new cases in Australia and Europe. Australia’s health agency released a similar report last month, saying that two cases have been observed in Western Australia and in Queensland.

At least one of the patients from Australia seems to have contracted the disease in southeast Asia, and while there aren’t any official figures available it seems as if certain regions of Asia suffer greatly from the disease. According to a study published in PLOS Medicine, approximately 19% of all cases of gonorrhea in China show resistance to the antibacterial medication azithromycin, one of the most common antibiotics used to fight the disease.

Photo: CDC, Public Domain

The primary treatments for gonorrhea are the aforementioned azithromycin and another drug called ceftiaxone. Unfortunately, the usefulness of these two antibiotics has continued to decrease as antibiotic-resistant strains of gonorrhea continue to multiply. Less frequently used antibiotics may help hold off the advancement of these strains, but it’s likely that the bacteria will evolve a resistance to these compounds as well.

Searching For New Solutions To An Old Problem

Drug-resistant bacteria have proliferated in the past few decades, despite humanity’s knowledge of the problem as far back as 70 years ago. Overuse of antibiotics has resulted in a variety of different microbes evolving resistances to set antibiotics. Yet back in 1945 when Alexander Fleming received the Nobel Prize in Physiology and Medicine for his discovery of penicillin, he warned the attending audience that “the ignorant man may easily underdose himself and, by exposing his microbes to non-lethal quantities of the drug, make them resistant.”

Yet Dr. Manica Balasegaram, from the Global Antibiotic Research and Development Partnership says though ignorance about drugs may expedite the evolution of drug-resistant diseases, all antibiotics inevitably become ineffective at some point or another. It’s only a matter of how fast the drugs become ineffective.

“All antibiotics will have a shelf life; that’s just evolution,” says Balasegaram.

The aim of the Global Antibiotic Research and Development Partnership (GARDP) is to improve upon existing treatments for bacterial infections and to develop new treatments capable of combating strains of disease that are resistant to current antibiotics. There are many different strains of antibiotic-resistant bacteria, including diseases like tuberculosis and pneumonia. However, the research firm has elected to focus much of its efforts on the treatment of gonorrhea.

Photo: jarmoluk via Pixabay, CC0

The GARDP is placing an emphasis on the treatment of gonorrhea for multiple reasons. One reason is that many antibiotics used to treat gonorrhea are used for other infections as well, and strains of gonorrhea are capable of integrating resistances and other bacteria rather quickly, enabling it to quickly create resistances to many different drugs. Gonorrhea infections can also cause a variety of different health problems as a consequence of the initial infection. In addition to causing infertility and pelvic inflammatory disease, gonorrhea can also increase the risk of contracting HIV, and the infection can pass to the child of an infected pregnant woman rendering the child blind.

Many who are affected by gonorrhea are asymptomatic, they don’t show any symptoms of the disease, meaning that it often goes untreated and undiagnosed. As a consequence, gonorrhea may live on in someone’s throat without their knowledge, where it can acquire resistances from other bacteria in the region that had been previously exposed to antibiotics.

Balasegaram says it’s critical that health agencies and health researchers prioritize advances in treatments for drug-resistant bacteria:

People are dying from drug-resistant infections. This is undoubtedly because this area has not been prioritized in the past because other areas of R&D are far more lucrative. Antibiotics are a global public good. I don’t think it’s easy to put a financial value to it.

A Worldwide Spread?

Indeed, though many of the reported cases of drug-resistant infections come from China, the problem is growing all around the world. A recent large-scale study done by the WHO examined incidences of drug-resistant gonorrhea in 77 countries all around the world. The study found that upwards of 80% of the countries which reported on the use of azithromycin to treat infections found resistance to the drug. Even more distressingly, about two-thirds of the countries tracked in the study found that there was resistance to a class of drugs called cephalosporins, which are traditionally recognized as being “last resort” antibiotics.

Dr. Tedora Wi, of the WHO’s Department of Reproductive Health and Research, argues that in reality, the landscape of drug-resistant bacteria could be even worse than the study found. Wi argues that surveys of drug-resistant bacteria diseases like gonorrhea are typically done in developed nations which have more resources to track the diseases. The problem is likely much worse in developing nations, yet of the 77 countries surveyed only a handful of those were from sub-Saharan Africa, where incidences of gonorrhea are amongst the highest in the world.

Experts say that the overuse of antibiotics is one of the things that has contributed to the quick rise of antibiotic-resistant bacteria, and that proper, restricted use of antibiotics will be important in the future. A recent study published in the BMJ found that many doctors across England had been prescribing the drug ciprofloxacin for treatment of gonorrhea even though scientists hadn’t recommended its use for treating the infection since 2005. The misapplication of the drug was so severe that almost half of all prescriptions for gonorrhea were ciprofloxacin in 2007.

Better regulation of the drugs that doctors may prescribe to patients for diseases will likely be necessary to prevent the exacerbation of drug-resistant bacteria. Yet it will be equally important for new treatments for bacterial infections to be developed.