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Gonorrhoea antibiotic-resistance on the rise

GENEVA, July 9, GNA –
Data from 77 countries show that antibiotic resistance is making gonorrhoea – a
common sexually-transmitted infection – much harder, and sometimes impossible,
to treat.

Gonorrhoea, a common
sexually transmitted infection is gaining notoriety for resisting antibiotic
treatment of the disease.

Dr Teodora Wi, Medical
Officer, Human Reproduction at the World Health Organisation (WHO) said:
“The bacteria that causes gonorrhoea are particularly smart. Every time we
use a new class of antibiotics to treat the infection, the bacteria evolve to
resist them.”

WHO reports widespread
resistance to older and cheaper antibiotics. Some countries – particularly
high-income ones, where surveillance is best – are finding cases of the
infection that are 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,” adds Dr Wi.

In a release copied to
the Ghana News Agency, an estimated 78 million people are infected with
gonorrhoea, each year.

Gonorrhoea can infect
the genitals, rectum, and throat. Complications of gonorrhoea disproportionally
affect women, including pelvic inflammatory disease, ectopic pregnancy and
infertility, as well as an increased risk of HIV.

It said decreasing
condom use, increased urbanisation and travel, poor infection detection rates,
and inadequate or failed treatment all contribute to this increase.

Monitoring
drug resistance

The WHO Global
Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in
drug-resistant gonorrhoea.

WHO GASP data from
2009 to 2014 find widespread resistance to ciprofloxacin- 97 per cent of
countries that reported data in that period found drug-resistant strains,
increasing resistance to azithromycin- 81 per cent and the emergence of
resistance to the current last-resort treatment, the extended-spectrum
cephalosporins (ESCs) oral cefixime or injectable ceftriaxone- 66 per cent.

Currently, in most
countries, ESCs are the only single antibiotic that remain effective for
treating gonorrhoea. But resistance to cefixime – and more rarely to
ceftriaxone – has now been reported in more than 50 countries.

As a result, WHO issued
updated global treatment recommendations in 2016 advising doctors to give two
antibiotics: ceftriaxone and azithromycin.

Development
of new drugs

The research and
development R&D pipeline for gonorrhoea is relatively empty, with only 3
new candidate drugs in various stages of clinical development: solithromycin,
for which a phase III trial has recently been completed; zoliflodacin, which
has completed a phase II trial; and gepotidacin, which has also completed a
phase II trial.

The development of new
antibiotics is not very attractive for commercial pharmaceutical companies.

Treatments are taken
only for short periods of time- unlike medicines for chronic diseases and they
become less effective as resistance develops, meaning that the supply of new
drugs constantly needs to be replenished.

The Drugs for
Neglected Diseases initiative (DNDi) and WHO have launched the Global
Antibiotic Research and Development Partnership (GARDP), a not-for-profit
research and development organization, hosted by DNDi, to address this issue.

GARDP’s mission is to
develop new antibiotic treatments and promote appropriate use, so that they
remain effective for as long as possible, while ensuring access for all in
need.

One of GARDP’s key
priorities is the development of new antibiotic treatments for gonorrhoea.

“To address the
pressing need for new treatments for gonorrhoea, we urgently need to seize the
opportunities we have with existing drugs and candidates in the pipeline.

“In the short term, we
aim to accelerate the development and introduction of at least one of these
pipeline drugs, and will evaluate the possible development of combination
treatments for public health use,” said Dr Manica Balasegaram, GARDP
Director.

“Any new
treatment developed should be accessible to everyone who needs it, while
ensuring it’s used appropriately, so that drug resistance is slowed as much as
possible.”

Gonorrhoea
prevention

Gonorrhoea can be
prevented through safer sexual behaviour, in particular consistent and correct
condom use. Information, education, and communication can promote and enable
safer sex practices, improve people’s ability to recognize the symptoms of
gonorrhoea and other sexually transmitted infections, and increase the
likelihood they will seek care.

It said lack of public
awareness, lack of training of health workers, and stigma around sexually
transmitted infections remained barriers to greater and more effective use of
these interventions.

It noted there were no
affordable, rapid, point-of-care diagnostic tests for gonorrhoea.

Many people who are
infected with gonorrhoea do not have any symptoms, so they go undiagnosed and
untreated.

On the other hand, however,
when patients do have symptoms, such as discharge from the urethra or the
vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even
though people may be suffering from another kind of infection.

The release said the
overall inappropriate use of antibiotics increased the development of
antibiotic resistance in gonorrhoea as well as other bacterial diseases.

Dr Marc Sprenger,
Director of Antimicrobial Resistance at WHO said: “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.”

“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.”

GNA

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