Monday 28 May, 2018

Drug resistant Gonorrhea on the increase

If you needed another reason to protect yourself during sex, here's one. 

Gonorrhea, a sexually transmitted disease that can infect the genitals and throat, is now resistant to antibiotics, making it much harder to treat. 

The World Health Organisation (WHO) said that data from 77 countries show the effect of antibiotic resistance to the disease 

"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," said Dr Teodora Wi, Medical Officer, Human Reproduction, at WHO.

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.

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 HIV.

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

The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP), monitors trends in drug-resistant gonorrhoea. WHO GASP data from 2009 to 2014 found widespread resistance to ciprofloxacin, increasing resistance to azithromycin, and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone.

Currently, in most countries, ESCs are the only single antibiotic that remains 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.

Added to the concern is the fact that the research and development pipeline for gonorrhoea is relatively empty, with only three new candidate drugs in various stages of clinical development.

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 organisation, 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."