Copenhagen, 9 October 2015. Almost 400,000,000 people worldwide aged 15-49 years acquire one of four sexually transmitted infections (STIs) each year, as Prof. Colm O’Mahony, MD (Chester, UK) pointed out at the EADV Congress in Copenhagen today. The numbers are alarming:
Neisseria gonorrhoea: A Potential Public Health Crisis Looming?
Neisseria gonorrhoea has developed resistance to all the antibiotics ever used against it. The bacteria can acquire resistance in several ways: by acquiring plasmids, by transformability (ability to acquire DNA from the environment and incorporate it in the genome) and by standard mutational resistance. Third-generation cephalosporins have previously been used in the treatment of N. gonorrhoea, but it was only a matter of time until the bacteria acquired resistance. A strain of N. gonorrhoea (H041 strain) resistant to this antibiotic was first identified in a female sexual worker in Japan in 20111.
Efforts to stem the spread of cephalosporin resistance are currently focused on:
In addition to these efforts, a number of new agents targeted against N. gonorrhoea are being investigated in clinical trials (see recently published review4).
5.6 million people – equivalent to the population of Denmark – acquire syphilis every year
… and the single-dose oral standard therapy no longer works. Surprisingly, syphilis has recently developed resistance to azithromycin. The only alternative left is injectable penicillin. It is still effective, but due to the method of administration it is less convenient and more cost-intensive (which is a problem for less-developed countries). Moreover, many people are allergic to penicillin.
Even more alarmingly, just this month, 11 new cases of highly resistant gonorrhoea have been found in the UK, mainly in the Leeds area. This strain is completely resistant to Azithromycin - part of the dual therapy needed for gonorrhoea. This is a major concern.
(1) Unemo, Golparian, Nicholas, Ohnishi, Gallay, Sednaoui (2011) High-Level Cefixime- and Ceftriaxone-Resistant Neisseria gonorrhoeae in France: Novel penA Mosaic Allele in a Successful International Clone Causes Treatment Failure. Antimicrobial Agents and Chemotherapy 1273-1280
(4) Lancaster JW, Mahoney MV, Mandal S et al. Update on Treatment Options for Gonococcal Infections. Pharmacotherapy 2015 Sep 6.. [Epub ahead of print]