The World Health Organization is warning that gonorrhea, the second most common bacterial sexually transmitted disease, is becoming resistant to all major antibiotics and few new drugs are in the pipeline. The WHO recently confirmed three cases that did not respond to even last-resort drugs. Prevention through safer sex and proper use of condoms is more important than ever, health officials say.
“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 gonorrhea is actually more common,” said Dr. Teodora Wi, Medical Officer, Human Reproduction, at WHO.
It’s estimated that 78 million people, most of them under 25, contract the disease worldwide each year. Gonorrhea can infect the genitals, rectum, and throat. Complications disproportionately 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 the increase. The U.S. Centers for Disease Control and Prevention last month issued a video calling gonorrhea antibiotic resistance an “urgent public health issue.”
Adding to the dilemma, health officials say the R&D pipeline for gonorrhea is relatively empty, with only three promising new drugs in various stages of development: solithromycin; zoliflodacin; and gepotidacin.
The problem with development is that antibiotics aren’t very attractive to commercial drug companies. They are used for only a short time, compared to drugs for chronic diseases that may be taken for many years. Also, since bacteria quickly develop resistance, new drugs are soon ineffective, leaving drugmakers to develop new ones.
Prevention offers the best near-term option, WHO officials say. Condom use and careful sexual practices can prevent most cases of the disease. Today, lack of public awareness, lack of training of health workers, and stigma around STDs are barriers to effective prevention.
“To control gonorrhea, 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.”