Antibiotic Resistant Gonorrhea Leaves No Cure in Sight

The rise of 'super-gonorrhea' - antibiotic resistant mutant, is alarming doctors in the UK with Dame Sally Davis, England's Chief Medical Officer issuing a statement to all doctors and pharmacists warning them that gonorrhea could become untreatable due to rising levels of resistant strains.

Gonorrhea a sexually transmitted disease caused by Neisseria gonorrhoeae is treated by a first-line antibiotics like ampicillin, amoxicillin, ceftriaxone, cefixime amongst others, but now strains have been identified which are resistant to these antibiotic drugs. Ceftriaxone-resistant gonorrhea strain named H041 was isolated from a female sex worker in Japan in the year 2011. This isolate was studied by Makoto Ohnishi and colleagues in a landmark study that brought salient features of antibiotic resistance to the fore like:

• The emergence of a new mutant variant of Neisseria gonnorhoea which was resistant to even ceftriaxone antibiotic.
• The isolation of this variant in a high-risk population indicates risk of further spread.
• H041 is a subclone of cefixime-resistant variants, indicating growing resistance to antibiotics
• The disease resistant version could spread dramatically via sex tourists and truck drivers.

The identification of disease resistant versions in Japan were of particular significance as previous isolation of resistant strains were associated with spread to Pacific rims, United States, Europe and global dissemination.

The letter from Dame Sally is after a series of identification of azithromycin-resistant strains of gonorrhea in The UK, first in Leeds in March, followed by 16 other cases, including in Macclesfield, Oldham and Scunthorpe.

Will Superbug be a Reality?

The hike in the identification of antibiotic resistant strains of gonorrhea and the rate of mutation pose added risk of a superbug invasion. This would, in theory, make gonorrhea untreatable. Scientists have found that gonorrhea is the strongest living organism in the biological world.

“We know the bacterium that causes gonorrhea can mutate and develop new resistance, so we cannot afford to be complacent” said Dr. Andrew Lee, who is a consultant in communicable disease control with Public Health England.

Does Everyone Exhibit Symptoms?

In about 10% of men and 50% of women, the symptoms are not expressed. Untreated gonorrhea, however, can lead to infertility and pelvic inflammatory disease.

Initially, the infection results in a white to yellowish discharge without the onset of any ‘active’ symptoms, which can result in spread to other individuals during sex.

With the rise in the number of disease resistant cases, it is important to actively prevent the spread of disease by:

• Controlling the prescription of antibiotics. An example would be the continued use of the antibiotic ciprofloxacin, which is considered unnecessary for gonorrhea but is still prescribed in 42% of the cases.
• Ensuring protection during sex
• Care while handling/ reusing sex toys

Gonorrhea is the second most common sexually transmitted disease after chlamydia with 78 million cases reported every year, according to the WHO. Considering the high incidence of this sexually transmitted disease, the emergence of antibiotic resistant variants would be alarming, as stated by Dame Sally “Gonorrhea is at a risk of becoming untreatable due to the continuing emergence of antimicrobial resistance”.

References:

1. http://aac.asm.org/content/55/7/3538.full

2. http://www.womenshealth.gov/publications/our-publications/fact-sheet/gonorrhea.html

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3. http://www.nejm.org/doi/pdf/10.1056/NEJM197601012940102

Source-Medindia