First cases of extensively drug-resistant gonorrhea threaten future treatment

May 14, 2018, European Centre for Disease Prevention and Control (ECDC)
Credit: CDC

Within a matter of weeks, three cases of gonorrhea that are resistant to the recommended first-line antibiotic treatment have been detected in Europe and Australia. At a time with limited alternatives to the current dual therapy, lack of a vaccine and insufficient surveillance capacity in some regions, these cases highlight the growing threat of drug-resistance—which could lead to untreatable gonorrhea.

With more than 75 000 reported cases in 2016, gonorrhoea is the second most commonly notified (STI) in Europe. Successful gonorrhoea treatment with antibiotics not only reduces the risk of complications such as , ectopic pregnancies, infertility or increased HIV transmission in some settings, but—combined with regular testing—also serves as one of the main public health strategies for reducing further transmission.

However, over the past decades, Neisseria gonorrhoeae has been developing resistance to several antimicrobial classes.

Between February and March 2018, the United Kingdom (1) and Australia (2) notified the first three cases globally of extensively drug-resistant Neisseria gonorrhoeae with high-level resistance to azithromycin and ceftriaxone resistance that are thus not susceptible to the currently recommended first line dual therapy for gonorrhoea (ceftriaxone intramuscularly and azithromycin orally). These cases were not epidemiologically linked.

The control of gonorrhoea depends on , including promoting safer sex practices (in particular the use of condoms), regular testing of individuals at risk as well as treatment with effective antibiotics to reduce the chance of further transmission.

In the EU/EEA, the largest proportion of reported gonorrhea cases in 2015 was among 25- to 34-year-olds (36 percent of cases) and 15-24 year olds (35 percent of cases). Credit: ECDC

Even a small change in drug resistance may have a broader impact as those infected can continue to transmit the infection without knowing. Spread of extensively drug-resistant strains like the ones identified in the UK and Australia can have an even more serious impact on the control of gonorrhoea.

How do we keep gonorrhoea treatable?

In its Rapid Risk Assessment, ECDC outlines the necessary steps to respond to the threat of multidrug- and extensively drug-resistant gonorrhoea: across disciplines, clinicians, microbiologists, epidemiologists and authorities at national and international level need to work closely together to preserve ceftriaxone and azithromycin as viable treatment options for this bacterial infection.

The most important actions needed are:

  • primary prevention interventions, such as sexual education and promotion of barrier methods (condom use), aiming to reduce the overall prevalence of gonorrhoea;
  • effective identification and management of infected patients, by ensuring that all those infected are promptly diagnosed and appropriately treated and receive a follow-up test of cure as recommended in current patient management guidelines;
  • reminding those diagnosed with gonorrhoea of the importance of partner notification and of attending for their test of cure.

The reported cases of extensively drug-resistant also highlight the need for developing novel antimicrobials for this disease as well as prioritisation and funding of an effective vaccine.

Explore further: Gonorrhoea strains across Europe becoming more susceptible to main treatment options

More information: ecdc.europa.eu/en/publications … a-gonorrhoeae-united

Related Stories

Gonorrhoea strains across Europe becoming more susceptible to main treatment options

September 13, 2017
According to test results from the annual European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), resistance levels to the main antimicrobials used for treatment of gonorrhoea infection have seen an encouraging ...

Push to control gonorrhoea as resistance threat looms

December 15, 2017
Australia's rising number of gonorrhoea cases has been described as a potential 'perfect storm', with the emergence of extensively drug resistant strains overseas.

Europe sees constant increase in gonorrhoea infections

May 31, 2016
Since 2008, the overall rate of reported gonorrhoea infections has more than doubled across Europe, going up from 8 per 100 000 population to 20 cases per 100 000 persons in 2014.

Encouraging decrease in certain antibiotic resistance levels of gonococci across Europe

September 2, 2016
In 2014, the susceptibility of gonococci to two of the recommended antibiotics for gonorrhoea treatment has shown signs of improvement, according to results from the European Gonococcal Antimicrobial Surveillance Programme ...

Reviving old drugs could help to stem the rise of drug-resistant gonorrhoea

November 1, 2017
A new study suggests a drug that was used in the past to treat gonorrhoea could help tackle infections that are resistant to current treatments.

New drugs needed against gonorrhoea: UN

July 7, 2017
New drugs are urgently needed to treat gonorrhoea, a sexually-transmitted disease threatening to veer out of control as it develops resistance to existing antibiotics, the UN's health agency said Friday.

Recommended for you

More frequent checks control MRSA in newborns, but can hospitals afford them?

May 22, 2018
The more often a hospital can check its newborns for deadly MRSA germs, the more likely it will be that they are contained, according to a new study.

Could we predict the next Ebola outbreak by tracking the migratory patterns of bats?

May 22, 2018
Javier Buceta, associate professor of bioengineering, Paolo Bocchini, associate professor of civil and environmental engineering, and postdoctoral student Graziano Fiorillo of Lehigh University have created a modeling framework ...

Helping preterm infants grow bigger kidneys would prevent kidney disease later in life

May 21, 2018
Nephrons are the microscopic blood-filtering units inside our kidneys that convert waste products into urine, regulate our electrolyte levels and our blood pressure.

Kidney docs worry over no dialysis for undocumented immigrants

May 21, 2018
(HealthDay)—Undocumented immigrants in the United States are often denied treatment for kidney failure until they have a life-threatening emergency. Now a new study finds that the doctors and nurses who treat them are frustrated ...

Clues found to early lung transplant failure

May 21, 2018
Among organ transplant patients, those receiving new lungs face a higher rate of organ failure and death compared with people undergoing heart, kidney and liver transplants. One of the culprits is inflammation that damages ...

How to ethically conduct clinical research during public health emergencies

May 21, 2018
Following the 2014-2015 Ebola outbreak in West Africa, the U.S. National Academy of Sciences, Engineering and Medicine established a committee to assess the clinical trials conducted in Guinea, Sierra Leone and Liberia. In ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.