Addressing the rising rates of gonorrhea and drug-resistant gonorrhea: There is no time like the present

Abstract

Increasing rates of gonococcal (GC) infection and antimicrobial resistant (AMR) GC, are a serious public health concern for Canada and around the world. Previously recommended treatments are ineffective against many of the gonorrhea strains circulating today. The current recommendation for combination therapy is now being threatened by globally emerging and increasingly resistant strains. It is important that coordinated efforts be made now to ensure these new global strains do not become established in Canada. Otherwise, we will be faced with the possibility of persistent GC infection which can lead to pelvic inflammatory disease, infertility and chronic pelvic pain in women; and epididymitis in men. The presence of GC can also increase the risk of HIV acquisition and transmission. There are a number of reasons why we are facing this public health threat. GC infection is often asymptomatic and it is highly transmissible. People may hesitate to seek testing (or to offer testing). Treatment is complex: recommendations vary by site of infection and risk of resistance. Sexual contact during travel is an important source of imported emerging resistant global strains. The new screening and diagnostic Nucleic Acid Amplification Test (NAAT) is excellent but has decreased the number of cultures being done and therefore our capacity to track AMR-GC. There are four key actions that clinicians and front-line public health professionals can take to stem the increase in rates of GC and drug resistant GC. First, normalize and increase GC screening based on risk factors and emphasize the need for safer sex practices. NAAT is useful for screening, but culture is still needed for extra-genital sites. Second, conduct pretravel counselling and include a travel history as part of the risk assessment. Third, use culture along with NAAT to establish the diagnosis and follow up for test-of-cure. Finally, refer to the most current Canadian Guidelines on Sexually Transmitted Infections or provincial/territorial recommendations on combination therapies for patients and their contacts as recommendations may have changed in response to evolving AMR-GC trends.

Implementation of antimicrobial stewardship to reduce antimicrobial drug resistance

“…After implementing antimicrobial stewardship programs in the emergency department, a markedly reduced number of unnecessary antimicrobial prescriptions (25.6% before the program vs. 17.4% after the program) were found in the outpatient [8]. Such improper clinical use of antimicrobial agents resulted in increased resistance with higher numbers of deaths from treatable and curable infections before the emergence of resistance [9,10]. For example, the conventional treatment for the sexually transmitted disease gonorrhea is azithromycin and ceftriaxone.…”

Commentary: Microbial Resistance Movements: An Overview of Global Public Health Threats Posed by Antimicrobial Resistance, and How Best to Counter

“…In a similar line of observation, the Centers for Disease Control and Prevention (CDC) reported that during 2010–2011, around 154 million times, antibiotics were prescribed in the ambulatory care settings in the U.S., of which ~47 million were estimated as unnecessary or inappropriate prescriptions ( 6 ). Such an irrational use of antimicrobial drugs partly contributed to the development of resistance against the microorganisms, once treatable before the emergence of resistance ( 7 , 8 ). One unfortunate example would be the treatment of gonorrhea.…”

Neisseria gonorrhoeae Multivalent Maxibody with a Broad Spectrum of Strain Specificity and Sensitivity for Gonorrhea Diagnosis

“…Recently, ertapenem has rapidly emerged as a gonorrhea treatment due to multidrug-resistant gonorrhea [ 14 , 15 ]. However, gonorrheal treatment failure with dual antimicrobial therapy (ceftriaxone combined with azithromycin or doxycycline) has been confirmed worldwide, as well [ 16 , 17 , 18 , 19 , 20 ]. Thus, the limited treatment options and the spread of hyper-variant ceftriaxone and azithromycin-resistant N. gonorrhoeae strains are significant public health concerns.…”