The sexually transmitted disease gonorrhoea is becoming much harder to treat due to the spread of antibiotic resistance, the World Health Organisation has warned. The bacteria is even growing resistant to last-resort treatments, raising concerns that some patients will find themselves out of options.
Gonorrhoea affects around 78 million people around the globe annually. Caused by the bacteria Neisseria gonorrhoeae or gonococcus, the disease can be transmitted during unprotected sex or if people share sex toys that have not been washed.
The bacteria can infect the cervix, the urethra, the rectum, and in some cases, the throat or the eyes, with symptoms ranging from the pain while urinating to bleeding and abnormal discharges. However, for many people, the infection is asymptomatic and so they can pass on the infection as they have no idea they have it.
Gonorrhea is treated with antibiotics, but in recent years, common antibiotics have increasingly been failing.
"The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them," said Teodora Wi, Medical Officer for Human Reproduction at the WHO, in a statement.
Data from 77 countries suggest that there is now widespread resistance to older and cheaper antibiotics - and in some cases the infection even appears to be untreatable by all known antibiotics.
"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," Wi added.
Preventing the infection in the first place
To combat this antibiotic resistance, the WHO issued new guidelines in 2016 global advising doctors to give two antibiotics azithromycin and a last resort drug known as ceftriaxone.
It would now be crucial to boost efforts to find new antibiotics but only three new candidate drugs are currently in various stages of clinical development and this area of research is not very attractive to pharmaceutical companies because treatments are taken by patients only during a short period and they become less effective as resistance develops, meaning that the supply of new drugs constantly has to be replenished.
In this context, ambitious prevention strategies to stop infections from occurring in the first place are needed. Gonorrhoea can easily be prevented through safer sexual behaviour, in particular consistent and correct condom use so information campaigns to make the public more aware of the disease are needed.
Improving diagnosis and testing tools and processes will also be important. Many people who are infected with gonorrhoea do not have any symptoms, so they go untreated - systematic testing after unsafe sex would thus be helpful.
In contrast, patients who show symptoms are often automatically be treated - even though they may be suffering from another kind of infection.
This overall inappropriate use of antibiotics contributes to the problem by increasing the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases.
"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," concluded Marc Sprenger, Director of Antimicrobial Resistance at 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."