According to data from 77 countries, due to antibiotic resistance, it has become more difficult, if not impossible, to treat gonorrhea, which is a common sexually transmitted infection.
“The bacteria responsible for gonorrhea is particularly smart. Indeed, every time we use a new class of antibiotics to treat the infection, the bacteria evolves to resist it, “says Dr. Teodora Wi, MD, Reproductive Health Department at the World Health Organization (WHO) .
WHO reports widespread resistance to older antibiotics, which are also the least expensive. Some countries, particularly high-income countries, where surveillance is most effective, detect infections that no known antibiotics can treat.
“These cases represent only the tip of the iceberg because systems to diagnose and report incurable infections are lacking in low-income countries where gonorrhea is actually more common,” says Dr. Wi.
An estimated 78 million people are infected with gonorrhea every year *. Gonorrhea can cause infection of the genitals, rectum and throat. Complications resulting from the disease disproportionately affect women who are particularly at risk of pelvic inflammatory disease, ectopic pregnancy and infertility, and an increased risk of HIV infection.
The decline in condom use, urbanization and increased travel, low infection rates, and inadequate treatment or treatment failure contribute to this increase in cases.
Monitoring Drug Resistance
The WHO Global Program for Monitoring Gonococcal Resistance to Antimicrobials monitors trends in drug resistant gonorrhea. Data from the WHO global program for the period 2009 to 2014 indicate widespread resistance to ciprofloxacin [97% of countries reporting data during this period discovered drug-resistant strains]; Increased resistance to azithromycin [81%]; And the appearance of resistance to current treatment of last resort: cephalosporins with extended spectrum, namely cefixime (oral) or ceftriaxone (injectable) [66%].
Currently, in most countries, extended spectrum cephalosporins are the only antibiotics administered as monotherapy that remain effective in treating gonorrhea. However, more than 50 countries have now reported resistance to cefixime and more rarely to ceftriaxone. In view of the situation, in 2016, WHO published an update on global treatment recommendations, advising doctors to administer two antibiotics: ceftriaxone and azythromycin.
Development of new drugs
The research and development pipeline for gonorrhea is relatively undeveloped, with only 3 new drug candidates at different stages of clinical development, namely: solithromycin, whose Phase III trial has recently been successfully completed; Zoliflodacin that completed the Phase II trial; And gepotidacin, which also completed the Phase II trial.
The development of new antibiotics is not very attractive for commercial pharmaceutical laboratories. Treatments are administered only for short periods of time (unlike chronic disease medications) and become less effective as resistance develops, meaning that the stock of new drugs must be constantly reconstituted.
The Needs of Medicines Initiative (DNDi) and WHO launched the Global Partnership on Antibiotic Research and Development, a non-profit development research organization hosted by the DNDi Initiative, to Facing this problem. The Partnership’s mission is to design new antibiotic treatments and promote their use to keep them effective for as long as possible, while ensuring access to all those who need them. One of the Partnership’s main priorities is to develop new antibiotic treatments for gonorrhea.
“In order to respond to the urgent need for new treatments for gonorrhea, we must immediately seize the opportunities offered by existing drugs and drug candidates. In the short term we want to accelerate the development and introduction of at least one of these candidate drugs, and we will consider developing therapeutic combinations for public health use, “said Dr. Manica Balasegaram, Director Of the GARDP. “New treatments must be accessible to all who need them and must be used appropriately so that drug resistance is minimized as much as possible,” she added.
Prevention of gonorrhea
Gonorrhea can be prevented by adopting safer sexual behaviors, in particular the correct and regular use of condoms. Information, education and communication can promote safer sexual practices, enable people to better recognize the symptoms of gonorrhea and other sexually transmitted infections, and increase the likelihood that they will be treated.
Today, lack of knowledge of the general public, lack of training of health workers and the stigmatization of people with sexually transmitted infections remain obstacles to a wider and more effective use of these interventions.
For gonorrhea, there is no rapid diagnostic test, feasible at the place of care and affordable. Many people have no symptoms and therefore receive no treatment because the diagnosis is not made. On the other hand, when patients have symptoms, such as urethral or vaginal discharge, doctors often assume that they are gonorrhea and prescribe antibiotics – even if the patient sometimes suffers from another Type of infection. The inappropriate use of antibiotics makes the occurrence of resistance more frequent, for gonorrhea as for other bacterial diseases.
“To fight gonorrhea, we need new tools and systems to improve prevention, early diagnosis and more comprehensive follow-up and reporting of new cases, use of antibiotics , Resistance and therapeutic failures, “said Dr Marc Sprenger, Director of the WHO Antimicrobial Resistance Department. “In this case, we need new antibiotics and rapid, accurate diagnostic tests at the place of care – ideally, tests that predict which antibiotics will be effective against this infection. In the longer term, we need a vaccine to prevent gonorrhea, “he added* 35.2 million in the WHO Western Pacific Region; 11.4 million in the South-East Asia Region; 11.4 million in the African Region; 11.0 million in the Region of the Americas; 4.7 million in the European Region and 4.5 million in the Eastern Mediterranean Region.