The World Health Organization (WHO) has said antibiotic resistance is making gonorrhoea, a sexually-transmitted disease, “much harder and sometimes impossible” to treat, as it cited data from 77 countries including India. The global health body said every year, an estimated 35.2 million people were infected by the disease in the WHO’s Western Pacific Region and 11.4 million in the South-East Asian Region, which includes India. “Data from 77 countries show that antibiotic resistance is making gonorrhoea much harder, and sometimes impossible, to treat,” it said. Asked if India was a part of the 77 countries, the WHO, Geneva, replied, “India is part of the 77 countries and has been coordinating with the Antimicrobial Resistance (AMR) in gonorrhoea in South East Asia Region”. Each year, an estimated 78 million people are infected with gonorrhoea – which can infect the genitals, rectum, and throat.
It afflicts 11.4 million in the WHO African Region, 11.0 million in the WHO Region of the Americas, 4.7 million in the WHO European Region and 4.5 million in the WHO Eastern Mediterranean Region. Gonorrhoea disproportionately affects women, leading to pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased HIV risk. “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, WHO. WHO reports widespread resistance to older and cheaper antibiotics. Some countries – particularly high-income ones, where surveillance is among the best – are finding cases that are untreatable by all known antibiotics, it said.
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“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 Wi. Decreasing condom use, increased urbanisation and travel, poor infection detection rates and inadequate or failed treatment all contribute to this increase, the WHO said. The WHO Global Gonococcal Antimicrobial Surveillance Programme (WHO GASP) monitors trends in drug-resistant gonorrhoea. WHO GASP data from 2009 to 2014 underscore widespread resistance to ciprofloxacin, with 97 per cent of countries that reported data in that period finding drug-resistant strains. It also found increasing resistance to azithromycin [81 per cent], and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporins (ESCs) oral cefixime or injectable ceftriaxone [66 per cent].
Currently, in most countries, ESCs are the only single antibiotic 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, the WHO issued an updated global treatment recommendations in 2016 advising doctors to give two antibiotics – ceftriaxone and azithromycin, the WHO said. The global health body said the research and development pipeline for gonorrhoea is relatively empty, with only three new candidate drugs in various stages of clinical development. They are solithromycin, for which a phase-III trial was recently completed, and zoliflodacin and gepotidacin, which have both completed a phase-II trial. Gonorrhoea can be prevented through safer sexual behaviour, in particular consistent and correct condom use. Information, education, and communication can promote and enable safer sex practices, improve people’s ability to recognise the symptoms of gonorrhoea and other sexually transmitted infections, and increase the likelihood they will seek care, the WHO said.