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5 Reasons Gonorrhea Is Becoming More Difficult To Treat
The front page picture of The Star newspaper released into the market on Thursday, January 12, 2023 featured significantly on Kenyans' WhatsApp and social media statuses.
The newspaper's lead story was titled 'Super gonorrhea strikes Nairobians', with the report stating that the Kenya Medical Research Institute (KEMRI) was concerned about the increase in the number of gonorrhea cases that are becoming more difficult to treat among city dwellers.
Typical of Kenyans, they took to social media to warn their friends and followers that reckless sex was becoming costlier by the day.
Many captioned the front-page image with the Swahili words "soko ni chafu", to mean "more and more people have STIs out here", and, therefore, caution is needed when engaging in sexual intercourse, especially with new partners.
The World Health Organization (WHO) said in a recent report that in 2020, there were 82.4 million new gonorrhea infections among adolescents and adults aged 15 to 49 years worldwide, with most of the cases registered in Africa and the western Pacific regions.
Gonorrhea is the second most common bacterial sexually transmitted infection (STI) after chlamydia.
In 2020, the WHO said there were 129 million new chlamydia infections in the world, followed by gonorrhea at 82.4 million.
In total, there were 374 million new STIs registered that year, with trichomoniasis leading with 156 million cases. Syphilis new infections that year were 7.1 million globally.
The WHO says that more than one million STIs are acquired every day worldwide, the majority of which are asymptomatic.
Gonorrhea, one of the commonest STIs in Africa, is caused by the bacterium Neisseria gonorrhoeae.
It infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men.
The bacterium can also infect the mucous membranes of the mouth, throat, eyes, and rectum.
Symptoms
The Centers for Disease Control and Prevention (CDC) says gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner.
Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.
The signs of gonorrhea infection among men include a white, yellow, or green smelly urethral discharge that usually appears one to 14 days after infection, a burning pain when passing urine, testicular or scrotal pain.
Most women with gonorrhea are asymptomatic. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection, the CDC says.
The initial symptoms in women include increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms, says the CDC.
Serious health problems
Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease, which can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.
In men, untreated gonorrhea may lead to infertility. It can also spread to the blood and cause arthritis, tenosynovitis, and/or dermatitis, which can be life-threatening, says the CDC.
Gonorrhea can be diagnosed by testing urine, urethral specimen for men, or endocervical or vaginal specimen for women. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.
'Super gonorrhea'
Gonorrhea treatment has been effective over the years, though of late, the disease has become more resistant to drugs.
Dr. Teodora Wi, the WHO Medical Officer specialising in STIs, says the drug-resistant gonorrhea is now famously known as super gonorrhea.
"When we say 'super gonorrhea' we mean 'gonorrhea superbug'. These are extensively drug-resistant gonorrhea with high-level resistance to the current recommended treatment for gonorrhea (ceftriaxone and azithromycin) including resistance to penicillin, sulphonamides, tetracycline, fluoroquinolones, macrolides," said Dr. Wi as quoted by the WHO official website.
Why gonorrhea is resisting treatment
According to Dr. Wi, there are five reasons for the increased drug-resistance in gonorrhea treatment.
The reasons are unrestricted access to antimicrobials (products that kill or slow the spread of microorganisms), inappropriate selection and overuse of antibiotics, poor quality antibiotics, inherent genetic mutations within the organism which have contributed to the development of a pattern of resistance, and extra-genital infections (infections in the anus, throat and eyes).
Compared to other STIs such as syphilis, gonorrhea has the highest level of drug-resistance, the WHO says.
"The first line treatment of Benzathine penicillin remains highly effective, there has been evidence of resistance to azithromycin," said Dr. Wi.
Dr. Wi further said gonorrhea is extremely cruel to the reproductive system if left untreated.
If left untreated, gonorrhea exposes one to a five-fold increase of HIV transmission, infertility, inflammation; leading to acute and chronic lower abdominal pain in women, ectopic pregnancy and maternal death, first trimester abortion; and severe neonatal eye infections that may lead to blindness, said Dr. Wi.
Adults with gonorrhea are treated with a combined dose of antibiotics. Due to emerging strains of drug-resistant gonorrhea, the CDC recommends that uncomplicated gonorrhea be treated with the antibiotic ceftriaxone - given as an injection - with oral azithromycin (Zithromax).
If you're allergic to ceftriaxone, you might be given oral gemifloxacin (Factive) or injectable gentamicin and oral azithromycin.
"Increasing resistance to the last-line treatment for gonorrhea, poses a big challenge because it limits the treatment choices available for gonorrhea infections. The development of resistance clearly outpaces the development of new antibiotics. There is an urgent need to develop new treatment options for gonorrhea," says WHO's Dr. Teodora Wi.
Using a condom or other barrier method when engaging in sex can help lower one's chances of transmitting or contracting gonorrhea.
These barrier methods, however, won't always completely eliminate the risk of infection, especially if they aren't used properly.
Super Gonorrhea May Be Spreading From Antibiotic Overuse For Covid-19 Coronavirus
Will the Covid-19 coronavirus lead to much wider spread of drug-resistant gonorrhea in 2021? (Photo ... [+] credit should read FREDERIC J. BROWN/AFP via Getty Images)
AFP via Getty ImagesYou want 2021 to be super. But not in a super gonorrhea type of way.
"Super gonorrhea" is trending on Twitter right now because, well, why not? It's 2020, after all. And what better thing to have trend at the end of a year that brought us the Covid-19 coronavirus pandemic, a shortage of basically everything, constant drama in the White House, and a Presidential election that just won't end? Consider this sexually transmitted infection to be the pie à la mode, the night cap, the final wipe of 2020.
If you haven't figured it out yet, super gonorrhea is not super to have. It won't prompt you to tell your partner, "I just returned from the doctor's office, and I've got super news for you." Nah, telling him or her that you have super gonorrhea would be about as positive as saying that you have sexy syphilis or candy-coated chlamydia. Super gonorrhea isn't a comic book hero either, in case you are wondering:
If it were featured in a film, super gonorrhea would give Ghost Rider a run for worst comic book movie ever.
Instead, super gonorrhea results when the bacteria that causes gonorrhea, Neisseria gonorrhoeae, develops a high level of resistance to the antibiotics normally used to treat the infection: azithromycin and ceftriaxone. As I reported back in 2017 for Forbes, the World Health Organization (WHO) listed such strains of N. Gonorrhoeae on its world's most dangerous superbugs list. When making your bucket list, don't include anything on this WHO superbug list. "We've run out of ways to treat your infection," ranks up there with "no one can fly the airplane" or "the hull of the cruise ship that you are on is made out of pickles" on the list of things that you don't want to hear.
Then in 2018, I covered for Forbes a case of a man from the United Kingdom (U.K.) who had had a "super" sexual encounter while traveling in Southeast Asia. The man developed symptoms a month later and was diagnosed with super gonorrhea. As a result, the man's regular partner in the U.K. Had to get tested, but she fortunately tested negative for the superbug. It's not clear whether this couple remained together after the super revelation. After all, things like not knowing how to tango or infecting you with super gonorrhea can be deal breakers for some when it comes to dating. If the relationship did continue, the woman would have had quite a card to raise in future arguments such as, "what you won't take out the trash? Well, remember that time you had sex with someone else and almost gave me super gonorrhea?"
So why is super gonorrhea trending on Twitter when there are oh so many other things that can trend? Well, there are different possibilities:
But it looks like the trending stemmed from a WHO spokesperson telling The Sun that the overuse of azithromycin and the lack of services to treat sexually transmitted infections (STIs) during the Covid-19 coronavirus pandemic may be fueling the rise of super gonorrhea. Not the Sun as in that fiery ball in the sky that you shouldn't look at even during an eclipse but The Sun as in the U.K. Publication.
Indeed, use azithromycin more often can select for more resistant versions of N. Gonorrhoeae. Remember earlier this year when some were touting the use azithromycin along with hydroxychloroquine to treat Covid-19? And some political leaders jumped on this bandwagon? This was even before well-constructed and executed clinical studies were done to assess the safety and efficacy of such medications for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections. So this was an example of premature medication. Since then clinical studies have not found enough evidence to support such use. In a commentary in The Lancet, Catherine E. Oldenburg, PhD, an Assistant Professor and Thuy Doan, MD, PhD, an Associate Professor at the University of California, San Francisco, (UCSF) concluded "for patients with Covid-19, the addition of azithromycin to existing standard of care regimens does not appear to improve outcomes," after reviewing results from the COALITION II trial that evaluated adding azithromycin to hydroxychloroquine and standard of care to treat patients hospitalized with severe Covid-19.
As a result of the scientific evidence that has subsequently emerged, the National Institutes of Health (NIH) Covid-19 Treatment Guidelines Panel now "recommends against the use of chloroquine or hydroxychloroquine with or without azithromycin for the treatment of Covid-19" in hospitalized or non-hospitalized patients.
A worker is engaged in producing the Azithromycin antibiotic at the Biokhimik [Biochemist] ... [+] pharmaceutical company. Azithromycin was registered by the Russian Healthcare Ministry on June 23, 2020, and included in the guidelines for the treatment of COVID-19 patients. (Photo by Artyom Geodakyan\TASS via Getty Images)
Artyom Geodakyan/TASSFor everyone who may have said, "what's the harm in continuing to use azithromycin to treat SARS-CoV2 infections," well here's a super response. Using antibiotics indiscriminately on infectious diseases as if the medications were Nutella can encourage the growth of resistant organisms. Antibiotics like azithromycin are considered "broad spectrum" because they can kill or inactivate a wide range of different bacteria. It's like using a bomb rather than a rifle. That can be helpful when you don't know what is causing an infection or when there is no other option.
However, every time you use a broad spectrum antibiotic rather than a treatment that's a lot more targeted and specific, you risk wiping out friendlier bacteria and weaker versions of a pathogen like N. Gonorrhoeae, leaving stronger more resistant versions a more open field to flourish. The remaining stronger ones then multiply and become a lot more predominant. This is how more resistant versions of the bacteria take over and spread.
In the U.S., the five years from 2013 to 2018 saw an over sevenfold jump in the percentage of N. Gonorrhoeae samples that are less susceptible to azithromycin from 0.6% to 4.6%. The rise of azithromycin resistance in N. Gonorrhoeae has prompted a December 18 change in the Centers for Disease Control and Prevention (CDC) guidelines for treating uncomplicated gonorrhea. Rather than a two-drug azithromycin and ceftriaxone approach, the CDC is now recommending just one 500 mg injection of ceftriaxone. By "uncomplicated," the CDC means your run-of-the-mill gonorrhea infections of number one your urinary tract, number two your rectum, your genital areas, or your throat. If you don't know how each of these places can be affected by N. Gonorrhoeae, you may need to re-take sex ed. Of course, more complicated gonorrhea may require antibiotics.
One problem with the Covid-19 coronavirus pandemic is that other pathogens haven't necessarily taken a break. They haven't spent most of their time on Zoom calls muting each other and using the video filters while saying, "hey look at me, herpes with a hat." While humans social distancing may have limited the spread of some pathogens such as influenza, others may have had a good 2020.
The Covid-19 coronavirus pandemic has either closed or limited the efforts of clinics and other ... [+] efforts that normally aim to reduce the spread of sexually transmitted infections. (Photo by Derek Davis/Portland Portland Press Herald via Getty Images)
Portland Press Herald via Getty ImagesAfter all, the pandemic has not only prompted doctors to try different antibiotics to treat Covid-19 coronavirus, it has also reduced the availability of doctors to properly treat STIs. The pandemic has shut down many "non-essential" health services or dissuaded many patients from seeking proper medical care. Therefore, people may be running around with untreated infections or trying to self-treat with potentially inappropriate antibiotics.
As I've said repeatedly, the Covid-19 coronavirus pandemic has been exposing many of the problems that have already existed in society. Antibiotic-resistant bacteria is one of them. If nothing is done to better tackle this looming problem, pathogens like super gonorrhea will be far from gone baby gone in 2021 and beyond.
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Drugs For Treatment Of Gonorrhea
Gonorrhea is a very common sexually transmitted disease (STD) caused by a bacterium/superbug called Neisseria gonorrhoeae. It is spread during sexual intercourse- vaginal, oral, and anal.
CeftizoximeCeftizoxime is active against a wide range of gram-positive and gram-negative organisms and is used in the treatment of lower respiratory tract infections, gonorrhea, pelvic inflammatory disease that also has appropriate antichlamydial coverage, intra abdominal infections, septicemia, skin infections, bone and joint infections, and in infections that are resistant to other cephalosporins, aminoglycosides, or penicillins
Trade Names :Cefizox (250mg)Cefizox (500mg)Cefizox (1000mg)More ...
GrepafloxacinGrepafloxacin is an fluoroquinolones antibiotic, prescribed for certain types of infection such as chronic bronchitis, pneumonia, gonorrhea, urethritis and cervicitis and other infections.
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