Untreatable-Gonorrhea Hits Spotlight While WHO Issues New Treatment Guidelines

The World Health Organization (WHO) issued new guidelines for treating gonorrhea that reflect the looming threat posed by antibiotic resistance.

Under the U.N. health agency’s new directives, gonorrhea, a sexually transmitted disease (STD), should no longer be treated with a class of antibiotics called quinolones, because quinolone-resistant strains of the disease have emerged all over the world. [1]

Instead, the WHO recommends treating gonorrhea with another class of antibiotics, cephalosporins. The new guidelines replace precepts which haven’t been changed since 2003.

Facts About Gonorrhea

About 78 million people are infected with gonorrhea each year, according to the WHO.

In the United States, there are an estimated 800,000 new gonorrhea infections, and the same number of existing infections, each year. In 2012, there were 334,826 cases reported in the United States, which is a rate of 107 cases per 100,000 people. [2]

Read: 84-Page Report Outlines 9 Ways to Beat Antibiotic Resistance

Gonorrhea is a serious STD which, left untreated, can cause scar tissue to form in women’s fallopian tubes, leading to infertility. Additionally, the disease can result in ectopic pregnancy, and long-term pelvic and abdominal pain.

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles, which can make it difficult or impossible for a man to father a child.

In rare cases, gonorrhea can become life-threatening if it spreads to your blood or your joints. It also increases your chance of getting or giving HIV, the virus that causes AIDS.

Symptoms in women include:

• A painful or burning sensation when urinating
• Increased vaginal discharge
• Vaginal bleeding between periods

Symptoms in men include:

• A burning sensation when urinating
• A white, yellow, or green discharge from the penis
• Painful or swollen testicles

Both men and women can develop rectal infections that either cause no symptoms or cause the following symptoms:

• Discharge
• Anal itching
• Soreness
• Bleeding
• Painful bowel movements [3]

Gonorrhea and Antibiotic Resistance

Jonathan Zenilman, who studies infectious diseases at Johns Hopkins, had this to say about the evolving threat posed by gonorrhea due to drug resistance:

“Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline, and doxycycline – very commonly used drugs.

But one by one, each of those antibiotics – and almost every new one that has come along since – eventually stopped working. One reason is that the bacterium that causes gonorrhea can mutate quickly to defend itself.

If this was a person, this person would be incredibly creative. The bug has an incredible ability to adapt and just develop new mechanisms of resisting the impact of these drugs.” [1]

Quinolones have become useless against the bug.

Many high-income countries changed their guidelines for how gonorrhea should be treated years ago based on their own data. However, the WHO bases its guidelines on global needs, and they are vital for countries lacking good surveillance data. [4]

Read: Super Drug-Resistant Strain of Gonorrhea in England

Teodora Wi from WHO’s Department of Reproductive Health and Research in Geneva explained that not changing the guidelines would not only endanger human health, it would waste prodigious amounts of money. She said:

“We really wanted countries to remove quinolones as the treatment of choice. Imagine if African countries invest so much money just to buy quinolones and the bacteria are already resistant.”

The new guidelines won’t eradicate the problem of gonorrhea and antimicrobial resistance. Forty-six countries have reported gonorrhea strains with decreased susceptibility to cephalosporins; 10 of those countries have reported patients for whom none of the usual antibiotics were effective.

However, only 56 countries actually conduct the type of testing necessary to get a full picture of the scope of the problem. [5]

Vanessa Allen, chief of medical microbiology at Public Health Ontario in Toronto, Canada, said:

“We risk losing the last antibiotic class for the effective treatment of gonorrhea.” [4]

The alternative to antibiotics for gonorrhea is rather horrifying. Before the mid-20th century, when penicillin was introduced, treatment was incredibly painful. Allen said:

“Mechanical interventions included genital installation of large quantities of iodine solution instilled by urethral or vaginal catheters, or ‘hot boxes’ where a person’s body was put in a box to 43°C to try to kill off the organism and not the host.”

Read: Gonorrhea Could One Day be Untreatable

She added:

“A return to this preantibiotic era is becoming an increasing possibility unless we slow down the rate of resistance or develop new drugs soon enough.”

If cephalosporins fail to get rid of gonorrhea, doctors can try combinations of drugs, including older antibiotics like gentamicin and spectinomycin. Unfortunately, these antibiotics have been studied less and the bacterium that causes gonorrhea is known to become resistant to them very quickly.

The best option would be new antibiotics, which we simply don’t have, and pharmaceutical companies are in no big hurry to make, as they don’t generate much revenue. Said Wi:

“We will have to have new drugs in 5 years, I think.”

Sources:

[1] NPR

[2] LiveScience

[3] CDC

[4] Science

[5] STAT

CDC