Drug-Resistant Super Gonorrhea: A Global Threat to Public Health
Gonorrhea has been one of the most prevalent sexually transmitted infections that are usually treated with antibiotics. In the last couple of decades, there have been strains of gonorrhea developing resistance to the drugs used for its treatment, and the fear of its becoming an incurable infection throughout the world is a possibility. This developing resistance has called for urgent action as health professionals are alarmed by this sexually transmitted infection, with over 80 million cases reported globally each year.
19 September 2024
5 min read
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What is Gonorrhea?
Gonorrhea emanates from an infection caused by the bacterium Neisseria gonorrhoeae. Gonorrhea is always considered to be sexually transmitted through all sexual contact: vaginal, oral, or anal. It can also be transmitted from mother to child at birth. Symptoms generally include painful urination and abnormal discharge; however, a lot of people, especially women, do not show any symptoms at all.
If left untreated, gonorrhea can cause serious health problems, like Pelvic Inflammatory Disease, or PID, resulting in infertility, ectopic pregnancy, and an increased risk of HIV. Other complications in men include painful inflammation of the testicles and of the prostate, complications which might produce sterility.
The Spread of Gonorrhea Resistant to Drugs
Historically, gonorrhea was readily treatable with antibiotics such as penicillin. However, the bacteria N. gonorrhoeae have proven to be quite capable of adapting to become resistant to antibiotics. First, treatment options changed from sulfonamides and penicillin to fluoroquinolones and, most recently, to ceftriaxone.
MDR and XDR strains have, therefore, developed serious global public health concerns with respect to the treatment of gonorrhea. Both strains are showing resistance to critical antimicrobials, represented by azithromycin and ceftriaxone, which indicate the last effective treatment options.
How Did Drug Resistance Develop?
There are some fundamental key factors that drive the development of drug-resistant gonorrhea:
Overuse and Misuse of Antibiotics
The overuse of antibiotics, especially when patients do not take the full course of treatment, gives the bacterium N. gonorrhoeae an opportunity to adapt and develop resistance to such treatment. In some countries, antibiotics are available over-the-counter, which creates usage that is not controlled.
Adaptability of N. gonorrhoeae
The bacteria causing gonorrhea are highly capable of mutation and adaptation, acquiring resistance genes from other bacteria through horizontal gene transfer.
Lack of Surveillance
Most areas lack the proper surveillance to track the spread of these resistant strains. Without constant vigilance and dissemination of information, it is challenging to control outbreaks effectively.
Global Spread of Drug-Resistant Gonorrhea
WHO has classified drug-resistant gonorrhea as a "high-priority pathogen." Resistance to drugs has been reported in Japan, the United Kingdom, the United States, and Australia.
In 2016, the first case of super gonorrhea was reported by the U.K., a strain resistant to all available antibiotics. Further cases then emerged worldwide, including notable outbreaks in 2018 in Australia, where the patients were infected with strains resistant to the antibiotics azithromycin and ceftriaxone.
A 2021 CDC report showed that nearly 50% of gonorrhea infections in the U.S. had resistance to azithromycin, which has furthered changes in treatment protocols.
Self-Testing with Instant Gonorrhea Testing Kits
With the increased development of resistance to drugs commonly used for treating STI infections, including gonorrhea, instant testing kits are gaining in popularity. The home test kits have the advantage of offering privacy and convenience since one does not have to attend the clinic for screening.
Most rapid test kits are able to detect antigens or antibodies related to N. gonorrhoeae from urine or swab specimens; these are kits that provide results in minutes, much like home pregnancy tests. The ease and rapidity with which these tests can be conducted make them a potentially attractive option for early detection.
Benefits of Rapid Self-Testing
Privacy and Convenience: Self-testing precludes visits to the clinic, which can be an uncomfortable and stigmatizing experience for many.
Early Detection: Rapid results would therefore enable people to seek medical treatment in due time.
Decreased Transmission: Accessibility and frequency in testing would contain the rate of infection.
Impact of Drug-Resistant Gonorrhea
The implications are enormous as far as drug-resistant gonorrhea is concerned:
Increased Health Complications
If left untreated, gonorrhea can also lead to the long-term complication of reproductive organs, presenting as infertility and neonatal conjunctivitis among newborns. Neonatal conjunctivitis may lead to blindness if not treated.
Economic Burden
The upward spiral in resistance translates to a similar trend in treatment costs—longer hospitalizations, more expensive therapies, and increased diagnostic testing—puts a heavy burden on healthcare systems, particularly those with limited resources.
Increased HIV Risk
Gonorrhea increases susceptibility to HIV infection through the inflammation and damage it causes to the mucosa, promoting access to the virus deeper in the system.
Risk of Untreatable Infections
The failure of the current modes of treatments may have the whole world confronting an epidemic of untreatable gonorrhea. This might result in increased morbidity and mortality due to commonly presenting complications such as PID and resultant ectopic pregnancies or even the facilitation of HIV transmission.
What Can Be Done to Combat Drug-Resistant Gonorrhea?
First, some of the measures that can be taken to counter this menace of drug-resistant gonorrhea include:
Improved Surveillance
Resistance surveillance globally needs to be improved so as to monitor emerging strains and, thus, enable planning for outbreaks.
Prudent Use of Antibiotics
Unnecessary uses of antibiotics must be avoided. Stringent practices by healthcare providers and proper education on completion of full treatment courses are called for.
New Treatment Development
This, therefore, calls for the investment in research for new antibiotics and other alternative treatments, such as bacteriophage therapy and antimicrobial peptides.
Public Education and Safe Sex Practices
Public education regarding safe sexual practices, including the use of condoms correctly and consistently, along with regular screening for STIs, will help prevent gonorrhea.
Vaccine Development
While there is currently no vaccine for gonorrhea, existing studies could provide a critical strategy to reduce the global burden of infection.
Untreatable STD Epidemic
Real super gonorrhea-resistant to drugs—is an emerging, developing threat. Without proper coordination and action, we may face a wave of an untreatable epidemic with severe health and economic consequences. It is time for increased surveillance, safe sexual behaviors, and investment in new treatments and vaccines by governments, health organizations, and individuals. Hopefully, the right efforts will keep us ahead of this dangerous infection.
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