Untreatable gonorrhea spreading worldwide

A potentially dangerous sexually transmitted disease that infects millions of people each year is growing resistant to drugs and could soon become untreatable, the World Health Organization said Wednesday.

Scientists reported last year finding a “superbug” strain of gonorrhea in Japan in 2008 that was resistant to all recommended antibiotics and warned then that it could transform a once easily treatable infections into a global health threat.

“This organism has basically been developing resistance against every medication we’ve thrown at it,” said Dr. Manjula Lusti-Narasimhan, a scientist in the agency’s department of sexually transmitted diseases. This includes a group of antibiotics called cephalosporins currently considered the last line of treatment.

“In a couple of years it will have become resistant to every treatment option we have available now,” she told The Associated Press in an interview ahead of WHO’s public announcement on its ‘global action plan’ to combat the disease.

The WHO said those fears are now reality with many more countries, including Australia, France, Norway, Sweden and Britain, reporting cases of the sexually transmitted disease resistant to cephalosporin antibiotics.

“Gonorrhea is becoming a major public health challenge,” said Manjula Lusti-Narasimhan, from the WHO’s department of reproductive health and research. She said more than 106 million people are newly infected with the disease every year.

“The organism is what we term a superbug — it has developed resistance to virtually every class of antibiotics that exists,” she told a briefing in Geneva. “If gonococcal infections become untreatable, the health implications are significant.”

Gonorrhea is a bacterial sexually transmitted infection which, if left untreated, can lead to pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in babies, and infertility in both men and women.

Once considered a scourge of sailors and soldiers, gonorrhea – known colloquially as the clap – became easily treatable with the discovery of penicillin. Now, it is again the second most common sexually transmitted infection after chlamydia. The global health body estimates that of the 498 million new cases of curable sexually transmitted infections worldwide, gonorrhea is responsible for some 106 million infections annually. It also increases the chances of infection with other diseases, such as HIV.

It is one of the most common sexually transmitted diseases in the world and is most prevalent in south and southeast Asia and sub-Saharan Africa. In the United States alone, according to the Centers for Disease Control and Prevention (CDC), the number of cases is estimated at around 700,000 a year.

The WHO called for greater vigilance on the correct use of antibiotics and more research into alternative treatments for so-called gonococcal infections.

The emergence of drug-resistant or superbug strains of gonorrhea is caused by unregulated access to and overuse of antibiotics, which helps fuel natural genetic mutations within the bacteria.

Experts say an added problem with gonorrhea is that its strains tend to retain their genetic resistance to previous antibiotics even after their use has been discontinued.

Major producers of antibiotics for gonorrhea include global drug making giants GlaxoSmithKline, Pfizer and Abbott, as well as Indian firms like Cipla.

The WHO said it is not yet clear how far or wide drug resistance in gonorrhea has spread, as many countries lack reliable data. “The available data only shows the tip of the iceberg,” said Lusti-Narasimhan.

“Without adequate surveillance we won’t know the extent of resistance…and without research into new antimicrobial agents there could soon be no effective treatment for patients.”

‘Like passing razor blades’

Francis Ndowa, formerly the WHO’s lead specialist for sexually transmitted infections, said gonorrhea has not only adapted to elude antibiotics but developed less painful symptoms, increasing its survival chances.

“They used to say that if you have urethral gonorrhea you go to the toilet to pass urine, it would be like passing razor blades. It was that painful,” he explained. “Now people with gonorrhea sometimes…only notice the discharge if they look when they pass urine, it’s not that painful anymore.

“So the organism has readjusted itself to provide fewer symptoms so that it can survive longer. It’s an amazing interaction between man and pathogen.”

Experts say the best way to reduce the risk of even greater resistance developing – beyond the urgent need to develop effective new drugs – is to treat gonorrhea with combinations of two or more types of antibiotic at the same time.

This technique is used in the treatment of some other infections like tuberculosis in an attempt to make it more difficult for the bacteria to learn how to conquer the drugs.

Gonorrhea can be prevented through safer sexual intercourse. The WHO said early detection and prompt treatment, including of sexual partners, is essential to control sexually transmitted infections.

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