Cases of antibiotic-resistant gonorrhea appear to have reached critical mass.
A World Health Organization (WHO) report this month warned that cases of untreatable gonorrhea are on the rise worldwide, based on data from 77 countries.
“The bacteria that cause gonorrhea are particularly smart,” Dr. Teodora Wi, medical officer of human reproduction at WHO, said in the report. “Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”
A doctor who specializes in sexual health told Healthline that it’s crucial for health organizations to remain vigilant, for people to make responsible choices, and for healthcare providers to screen and treat appropriately.
Because the bacteria that cause gonorrhea are constantly evolving to resist new classes of antibiotics, the process of treating the infection has become a moving target.
This was evident last year when officials warned that a strain of “super gonorrhea” could be headed to the United States.
“One of the very curious and interesting things about this bacteria is that with every antibiotic that we have developed to help treat it, eventually the bacteria has developed resistance to it,” Jose Bazan, DO, medical director of the Sexual Health Clinic at Columbus Public Health, told Healthline.
“Over time, this has reduced our available antibiotics to help treat it. I think we are now probably at a critical point in which the number of consistently effective antibiotics that we have is severely limited, and I think that’s why everybody is sounding the alarm,” Bazan added.
Right now, the Centers for Disease Control and Prevention (CDC) recommendations for treating gonorrhea involve a regimen of two antibiotics: an intramuscular injection of ceftriaxone, plus oral azithromycin.
Who and why?
WHO officials note that 78 million people are infected with gonorrhea every year.
The increase is attributed to factors such as urbanization, lack of barrier protection like condoms, and inadequate or failed treatment.
In addition, more seniors, at least in the United States, are being diagnosed with sexually transmitted diseases (STDs) such as chlamydia and syphilis.
Reasons for this uptick also include older adults having more sex due to fertility drugs and improved physical health.
Another factor could be that, when consulting with their doctors, the subject of sex isn’t likely to come up.
“It falls on healthcare providers to advise their patients that if they’re sexually active, especially with multiple partners, or if they’re not using condoms on a routine basis, then they should be screened for gonorrhea and other STD’s,” said Bazan.
What’s being done
“On our radar screen, this has been an issue for a while,” said Bazan. “Focusing on the United States, we have a surveillance system in place which is called the Gonococcal Isolate Surveillance Project, or GISP, which is a national surveillance system that is run by the CDC.”
GISP conducts routine testing for antibiotic susceptibility of isolates of gonorrhea, collected from various sites around the country.
This information is then used to guide the CDC when it updates its national treatment recommendations. Similar systems are in place in other parts of the world.
Bazan said that the CDC has been proactive when it comes to detecting antibiotic-resistant gonorrhea, but there are still further steps that can be taken.
“GISP is very important,” he said. “It needs to continue, it needs to be funded, and it probably needs to be expanded.”
“We need to continue to enhance national surveillance programs in order to detect the emergence of resistance. We need to ideally develop what are called rapid point of care tests that are able to detect resistance quickly, rapidly, and hopefully cheaply. It’s also important to have plans in place to help detect and deal with potential outbreaks of drug-resistant gonorrhea quickly, so we can identify clusters or outbreaks, get them under control, and treat them. Funding is always very important, so we have to make sure that money is allocated to help combat the emergence of drug-resistant gonorrhea.”
On a local level, Bazan said it’s crucial that clinicians who treat people with gonorrhea always follow the most current CDC treatment recommendations.
Another helpful step would be to boost funding for STD prevention programs.
Vigilance is important
“There’s always a recommendation to practice safe sex, to use barrier protection, and to limit the number of sexual partners,” said Bazan. “It’s also important to get routine screening, even if symptoms are not present. Sometimes people can be infected with gonorrhea and not have any symptoms.”
From a clinician’s standpoint, fighting the rise of drug-resistant gonorrhea goes beyond simply treating patients.
“Clinicians always need to be on the lookout,” said Bazan. “If you treat your patient appropriately, and for some reason the patient doesn’t get better and the symptoms don’t resolve, then that should trigger a red flag. You may need to test that particular isolate just to make sure it’s not a resistant one. In all of this, the bottom line is that healthcare providers must keep abreast of the most up-to-date CDC gonorrhea treatment guidelines.”