Untreatable Antibiotic-Resistant Strains of Gonorrhoea Are Going Global

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The World Health Organisation (WHO) has issued a warning over the rise of resistant strains of the infectious bacteria responsible for gonorrhoea.

Superbugs are bad news at the best of times, but with little on the horizon by way of potential treatments for this common sexually transmitted infection (STI), we could very well be rewinding the clock on venereal disease.

The warning follows the discovery of several patients in France, Japan, and Spain who harboured strains of Neisseria gonorrhoeae that wouldn’t respond to any antibiotics.

WHO medical officer Teodora Wi predicts there are plenty more to come.

“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,” says Wi.

Gonorrhoea is one of the most common pathogens passed around through sexual contact, largely thanks to the fact it’s often asymptomatic, meaning people often don’t even know they have the bacteria.

Decreased use of condoms and a rise in travel also contribute greatly to its spread, with an estimated 78 million people infected annually.

The bacteria not only infect the genitals of men and women, but can be found in the tissues of the throat and rectum as well, and lead to complications including infertility and increased susceptibility to catching HIV.

Since the 1930s, bacterial STIs such as gonorrhoea, chlamydia, and syphilis have been treated with a simple course of antibiotics.

“The best time to have had gonorrhoea was the eighties, since there were many drugs to treat it with,” US director of the Centre for Disease Dynamics, Economics and Policy Ramanan Laxminarayan told Nature.

While non-symptomatic cases go untreated, in the absence of an on-the-spot diagnosis kit, doctors also have a tendency to assume STI based on reported symptoms alone, prescribing antibiotics regardless of the presence of infection.

The decades since have seen an increasing number of so-called superbugs – bacteria that have acquired a resistance to numerous antibiotics.

New research has found widespread resistance to several types of antibiotics commonly prescribed for gonorrhoea.

All but 3 percent of countries surveyed between 2009 and 2014 reported Neisseria gonorrhoeae with a resistance to a common and inexpensive antibiotic called ciprofloxacin. About 66 percent of countries reported resistance to a last-resort group of antibiotics called extended-spectrum cephalosporins (ESCs).

That’s seriously bad news, since in many countries ESCs are the only option left for treating gonorrhoea.

If we’re hoping for a miracle cure to pop up soon, we’ll be disappointed. There’s nothing much in the pipeline, with only 3 candidates being tested – one at the end of a phase 3 trial, and two that have just completed phase 2 trials.

The WHO has been vocal in the past about the reluctance of commercial companies to invest in pharmaceuticals where there is little hope of profit.

Following the 2014 outbreak of Ebola, an epidemic which claimed around 5000 lives, WHO director general Margaret Chan cited profit as the reason vaccines were slow in being developed.

“A profit-driven industry does not invest in products that cannot pay,” said Chan.

Similarly, antibiotics aren’t always appealing candidates for commercial pharmaceutical companies, since – somewhat ironically – bacteria can develop a resistance to them.

The WHO has joined forces with the Drugs for Neglected Diseases initiative to launch the Global Antibiotic Research and Development Partnership in order to address this dire issue.

“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,” says the partnership director Dr Manica Balasegaram.

Even if we develop more accurate and rapid diagnostic techniques and new antibiotics, prevention is far better than any cure.

The WHO will be publishing its research in PLOS Medicine prior to the STI & HIV World Congress in July.

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