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Biological Health Hazard – Antibiotic Resistant Gonorrhea Outbreak: WHO

2017/07/11

GONOCOCCAL DISEASE – ANTIBIOTIC RESISTANCE, WHO
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Published Date: 2017-07-11 13:18:16
Subject: PRO/EDR> Gonococcal disease – antibiotic resistance, WHO
Archive Number: 20170711.5166294

[1] Date: Sat 8 Jul 2017
Source: News Nation Bureau [edited]

Resistance to antibiotics is creating difficulty in treating gonorrhea and sometimes making it impossible to treat, according to the World Health Organization (WHO) reports based on data from 77 countries.

In India, there is an immense increase in antibiotic resistance. Much of the problem arises due to over prescription of drugs by doctors and irrational over-the counter sale of antibiotics. The data was evaluated through 2 latest studies published in international journal PLOS [1,2].

According to the data, each year around 78 million people are infected with gonorrhea on a global level. However, this might be an underestimation because only those countries where surveillance is best and with particularly with high income have cases of infection that cannot be treated 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,” said Dr Teodora Wi, medical officer, human reproduction, WHO.

“The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolves to resist them,” he added.

According to WHO Global Gonococcal Antimicrobial Surveillance Programme, in the years 2009-2014 (97 percent of countries that reported data in that period found drug-resistant strains) a widespread resistance to ciprofloxacin was found, resistance to azithromycin was reported by 81 percent countries, and the emergence of resistance to the current last-resort treatment, the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone was 66 percent.

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[1. Wi T, Lahra MM, Ndowa F, et al. Antimicrobial resistance in _Neisseria gonorrhoeae_: Global surveillance and a call for international collaborative action. PLOS Published: July 7, 2017 Available at:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002344
2. Alirol E, Wi TE, Bala M, et al. Multidrug-resistant gonorrhoea: A research and development roadmap to discover new medicines (PDF). Available at: https://www.gardp.org/wp-content/uploads/2017/07/Alirol_PLOS_multidrug-resistant_gonorrhea_2017.pdf.]

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[2] Date: Fri 7 Jul 2017
Source: WHO [edited]

Antibiotic-resistant gonorrhea on the rise, new drugs needed
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Data from 77 countries show that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat.

“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 urbanization 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 find widespread resistance to ciprofloxacin [97 percent of countries that reported data in that period found drug-resistant strains], increasing resistance to azithromycin [81 percent [of countries]], and the emergence of resistance to the current last-resort treatment, the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone [66 percent of countries]].

Currently, in most countries, ESCs are the only single antibiotics 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 2 antibiotics: ceftriaxone and azithromycin.

The R&D pipeline for gonorrhoea is relatively empty, with only 3 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.

“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.”

Gonorrhoea can be prevented through safer sexual behavior, in particular consistent and correct condom use. Information, education, and communication can promote and enable safer sex practices, improve people’s ability to recognize the symptoms of gonorrhoea and other sexually transmitted infections, and increase the likelihood they will seek care. Today, lack of public awareness, lack of training of health workers, and stigma around sexually transmitted infections remain barriers to greater and more effective use of these interventions.

There are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea. Many people who are infected with gonorrhoea do not have any symptoms, so they go undiagnosed and untreated. On the other hand, however, when patients do have symptoms, such as discharge from the urethra or the vagina, doctors often assume it is gonorrhoea and prescribe antibiotics – even though people may be suffering from another kind of infection. The overall inappropriate use of antibiotics increases the development of antibiotic resistance in gonorrhoea as well as other bacterial diseases.

“To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures,” said Dr Marc Sprenger, Director of Antimicrobial Resistance at WHO. “Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on that particular infection – and longer term, a vaccine to prevent gonorrhoea.”

Communicated by:
ProMED-mail
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[For a discussion of antibiotic resistance in _Neisseria gonorrhoeae_, please see my moderator comments in the prior ProMED-mail post Gonococcal disease – UK: azithromycin resistance, RFI 20150919.3656467 below. – Mod.ML]

See Also

2016
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Gonococcal disease – USA (05): (HI) ceftriaxone plus azithromycin resistance 20160924.4513277
Gonococcal disease – UK (02): azithromycin resistance, spread, MSM, RFI 20160910.4479782
Gonococcal disease – USA (03): increasing azithromycin resistance, 2014 20160716.4349791
Gonococcal disease – UK: (England) azithromycin monotherapy resistance, RFI 20160103.3907866

2015
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Gonococcal disease – UK: azithromycin resistance, RFI 20150919.3656467

2014
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Gonococcal disease – New Zealand: antibiotic resistance, new treatment guideline 20141209.3022856
Gonococcal disease – Australia: ceftriaxone resistance 20140826.2723627
Gonococcal disease – USA: increased ciprofloxacin resistance, disease incidence 20140405.2382582

2013
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Gonococcal disease – Sweden: increased cases, antibiotic resistance 20130619.1780579
Gonococcal disease – UK: increased cases, antibiotic resistance 20130301.1565249
………………………………………….sb/ml/ec/mpp

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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