Red alert to rise in untreatable gonorrhoea

Oral sex, decline in condom use, antibiotic resistance implicated by WHO
Oral sex is causing the spread of a dangerous gonorrhoea superbug, experts have warned. The untreatable strain of gonorrhoea is rapidly spreading across the world putting millions of lives at risk, the World Health Organisation (WHO) has warned.

Experts said that incurable gonorrhoea has started to spread after becoming resistant to antibiotics, which has been partly caused by oral sex and a decline in condom use.

The sexually transmitted bacteria can live at the back of the throat and, because of this, has been evolve immunity to antibiotics used to treat common throat infections.

The WHO issued a warning after it confirmed that three people had contracted the superbug.

The bacterial infection is normally treated with a short and simple dose of antibiotics. But gonorrhoea has become increasingly resistant to common antibiotics.

Bacteria become immune to antibiotics when they evolve new self defense mechanisms to stop the drugs from being effective. Antibiotic resistance is chiefly driven by the over-subscription of antibiotics, according to researchers.

In 2016, experts from the WHO warned that a ‘super’ strain of gonorrhoea could become immune to antibiotics in a ‘matter of years’.

But now experts from the WHO have said it is ‘only a matter of time’ before last-resort gonorrhoea antibiotics would be of no use at all.

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

Medical Officer, Human Reproduction, at the World Health Organisation (WHO), Dr. Teodora Wi, said: “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.”

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 Wi.

Each year, an estimated 78 million people are infected with gonorrhoea. 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 Human Immuno-deficiency Virus (HIV). 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.

The Research and Development (R&D) pipeline for gonorrhoea is relatively empty, with only three 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.