Is gonorrhoea becoming untreatable?
by Marita van de Laar
13 June 2012
With more than 32,000 cases in 2010, gonorrhoea is the second most commonly reported sexually transmitted infection in Europe – it may soon become untreatable due to resistance to anitbiotics - warns EU agency
While untreated gonorrhoea infections may lead to severe secondary complications like pelvic inflammatory disease, stillbirths and infertility in men and women - successful treatment not only reduces the risk of complications, but also serves as the main public health strategy for reducing further transmission. Effective control of gonorrhoea relies entirely on successful treatment with antibiotics and current treatment guidelines in Europe recommend the use of a single-dose the injectable ceftriaxone or the oral drug cefixime. However, recently published data show that gonococci have become more resistant to common agents for treatment and show reduced susceptibility to newer antibiotics.
Results from the European gonococcal antimicrobial surveillance programme show that the proportion of gonorrhoea cases with resistance to cefixime rose from 4 per cent in 2009 to 9 per cent in 2010. In addition, the drug-resistant strains are also spreading fast across the continent. They were found in 17 European countries in 2010, seven more than in the previous year. The overall trend in gonorrhoea across Europe indicates a slight decrease showing two patterns: a decreasing trend in a number of countries that previously reported very high rates - with present continuous decline or stabilisation - while continuous increases in other countries were observed over time. Public health experts and clinicians need to be aware of the current critical situation and should be vigilant for treatment failures.
In this scenario, our response plan represents the first regional programme following the World Health Organisation's warning that drug-resistant gonorrhoea may become a major public health challenge. The plan was developed in collaboration with an expert group, including STI microbiologists and the International Union against STI. It provides a framework for multidisciplinary interventions to control the threat of multidrug-resistant gonorrhoea and supports European Union members States in their national response to the threat.
Gonorrhoea is a sexually transmitted infection caused by bacteria called neisseria gonorrhoeae. It can infect areas of the reproductive tract, including the cervix, uterus and egg canals in women as well as the urine canal – urethra - in both women and men. As the bacterium can also infect the throat, eyes and rectum, a broad spectrum of clinical presentations can occur. Any sexually active person can be infected with gonorrhoea - which is spread through unprotected vaginal, oral or anal sex. Untreated gonorrhoea infections can lead to stillbirths and infertility in men and women. The infection can also be transmitted from mother-to-child during childbirth. Gonorrhoea also plays a role in facilitating HIV transmission.
Only continued surveillance of antimicrobial resistance in gonococci will inform existing and future treatment guidelines adequately in order to ensure that patients are treated with effective drugs and morbidity is reduced in infected patients. To this effect, the surveillance programme includes testing of isolates on antimicrobial resistance twice a year, an external quality assessment programme and training for laboratory staff. On the whole, future surveillance of STI in Europe at high level is essential in order to monitor the distribution of disease and to assess the public health response to control the transmission of infections as the actual number of STIs across Europe is likely to be several times higher than reported because many diagnoses are either not made or not reported.
Marita van de Laar is head of the STI programme at the European Centre for Disease Prevention and Control, a European Union agency
While untreated gonorrhoea infections may lead to severe secondary complications like pelvic inflammatory disease, stillbirths and infertility in men and women - successful treatment not only reduces the risk of complications, but also serves as the main public health strategy for reducing further transmission. Effective control of gonorrhoea relies entirely on successful treatment with antibiotics and current treatment guidelines in Europe recommend the use of a single-dose the injectable ceftriaxone or the oral drug cefixime. However, recently published data show that gonococci have become more resistant to common agents for treatment and show reduced susceptibility to newer antibiotics.
Results from the European gonococcal antimicrobial surveillance programme show that the proportion of gonorrhoea cases with resistance to cefixime rose from 4 per cent in 2009 to 9 per cent in 2010. In addition, the drug-resistant strains are also spreading fast across the continent. They were found in 17 European countries in 2010, seven more than in the previous year. The overall trend in gonorrhoea across Europe indicates a slight decrease showing two patterns: a decreasing trend in a number of countries that previously reported very high rates - with present continuous decline or stabilisation - while continuous increases in other countries were observed over time. Public health experts and clinicians need to be aware of the current critical situation and should be vigilant for treatment failures.
In this scenario, our response plan represents the first regional programme following the World Health Organisation's warning that drug-resistant gonorrhoea may become a major public health challenge. The plan was developed in collaboration with an expert group, including STI microbiologists and the International Union against STI. It provides a framework for multidisciplinary interventions to control the threat of multidrug-resistant gonorrhoea and supports European Union members States in their national response to the threat.
Gonorrhoea is a sexually transmitted infection caused by bacteria called neisseria gonorrhoeae. It can infect areas of the reproductive tract, including the cervix, uterus and egg canals in women as well as the urine canal – urethra - in both women and men. As the bacterium can also infect the throat, eyes and rectum, a broad spectrum of clinical presentations can occur. Any sexually active person can be infected with gonorrhoea - which is spread through unprotected vaginal, oral or anal sex. Untreated gonorrhoea infections can lead to stillbirths and infertility in men and women. The infection can also be transmitted from mother-to-child during childbirth. Gonorrhoea also plays a role in facilitating HIV transmission.
Only continued surveillance of antimicrobial resistance in gonococci will inform existing and future treatment guidelines adequately in order to ensure that patients are treated with effective drugs and morbidity is reduced in infected patients. To this effect, the surveillance programme includes testing of isolates on antimicrobial resistance twice a year, an external quality assessment programme and training for laboratory staff. On the whole, future surveillance of STI in Europe at high level is essential in order to monitor the distribution of disease and to assess the public health response to control the transmission of infections as the actual number of STIs across Europe is likely to be several times higher than reported because many diagnoses are either not made or not reported.
Marita van de Laar is head of the STI programme at the European Centre for Disease Prevention and Control, a European Union agency
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