Describing it as a "serious situation," the World Health Organisation has issued a grim warning about the dramatic rise of antibiotic resistant gonorrhoea around the world. The agency is now calling for the quick development of drugs to treat the sexually transmitted disease.
Neisseria gonorrhoeae, the bacteria responsible for gonorrhoea. (Image: National Institute of Biomedical Imaging and Bioengineering)
Data collected from nearly 80 countries shows that antibiotic resistance is making gonorrhoea much tougher, and at times impossible, to treat. The disease is becoming increasingly immune to older and cheaper antibiotics, and treatment-resistant strains are now appearing even in countries where monitoring practices are top notch. WHO, with help from a global team of researchers, is set to release these findings in a special edition of PLoS Medicine prior to the STI & HIV World Congress that will be held in Rio from July 9-12.
"The bacteria that cause gonorrhoea are particularly smart," said WHO medical officer Teodora Wi in a statement. "Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them."
Each year, the sexually transmitted disease afflicts an estimated 78 million people worldwide. Gonorrhoea is caused by the Neisseria gonorrhoeae bacterium, and it infects both men and women. Symptoms include a greenish yellow or whitish discharge from the penis and vagina, burning while urinating, swollen glands in the throat (due to oral sex), and other unpleasant manifestations. The disease is particularly tough on women, and it's frequently accompanied by pelvic inflammatory disease, infertility, ectopic pregnancy (when the fetus develops outside the uterus), and an increased risk of contracting HIV. WHO says the disease is spreading on account of decreased condom use, increased urbanisation and travel, poor detection measures, and inadequate or failed treatments.
Data collected by WHO from 2009 to 2014 shows widespread resistance to the commonly used antibiotics ciprofloxacin and azithromycin, along with emerging resistance to the current last-resort treatment involving injectable ceftriaxone. Superbugs that couldn't be treated with the last line of defence have been reported in France, Japan and Spain. The agency is now advising doctors to prescribe a double-whammy treatment involving both azithromycin and ceftriaxone. This is a rather grim prescription, given that azithromycin-resistant gonorrhoea is now being reported in 81 per cent of countries, and ceftriaxone-resistant gonorrhoea has taken root in 66 per cent of countries. Ultimately, WHO says we need to develop a vaccine, because gonorrhoea will always remain a step ahead of our efforts to curb it with antibiotics.
WHO is also calling for the rapid development of new drugs to treat the disease. Disturbingly, the research and development pipeline for gonorrhoea is relatively empty, with only three new candidate drugs currently in clinical development, according to WHO. Part of the problem has to do with Big Pharma's reluctance to develop drugs that treat gonorrhoea, which are only taken for short periods of time (unlike meds for chronic diseases), and become less effective over time as resistance develops.
"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," said Manica Balasegaram, who directs the not-for-profit Global Antibiotic Research and Development Partnership (GARDP). "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. 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."
In addition to developing new drugs and re-evaluating existing antibiotics, WHO says it's critical to develop treatments that are easier to administer, and produce more simplified treatment guidelines.
An 18-month review into antimicrobial resistance warns that superbugs will kill upwards of 10 million people a year by 2050, a frightening prospect that's being described as 'the antibiotic apocalypse'.
This latest development is another discouraging reminder that our antibiotics are failing. Last year, the Institute and Faculty of Actuaries in Britain claimed that a new era of antimicrobial resistance is already upon us, and that 50,000 people are already dying each year in the US and Europe from untreatable infections. Should nothing be done to offset this trend, as many as 10 million people could die each year by the mid-point of the 21st century, making antimicrobial resistance more deadly than cancer.
Antibiotics that treat gonorrhoea may be failing, but there's still a way to fight back: Practice safe sex.