Neisseria gonorrhoea is considered to be one of the superbugs which seem to become resistant to almost all available microbial agent currently in use. When left untreated Neisseria gonorrhoea infection leads to severe complications such as PID or pelvic inflammatory disease, ectopic pregnancy, infertility and also raises the risk of abortion within the first trimester, eye infection in newborns.
Penicillin G was the first antimicrobial agent which successfully used for Gonoccocal infection in 1943 and followed for more than 40years until the emergence of resistant species. However, for last 70-80 years, treatment of Neisseria gonorrhoea becomes complicated as the antimicrobial strain of Neisseria gonorrhoea become highly prevalent showing resistance to almost all antimicrobial available such as tetracyclines, or fluoroquinolones. According to the first report of Center of Disease Control and Prevention or CDC, published in the year 2013, drug-resistant Neisseria gonorrhoea was reported as one of three main threats to the USA. Especially for the last 2 years, the existence of resistance strain against ceftriaxone, the last available effective antimicrobial agent has been reported from Japan. To deal with the situation, the World Health Organization or WHO has implemented ‘Global Action Plan to Control the Spread and Impact of Antimicrobial Resistance in Neisseria gonorrhoea’. Accordingly, CDC, US and CDC, Europe also published specific plans for accordingly regional distribution.
How Gonorrhoea becomes drug resistant?
Chromosomal mutation or addition of resistance circular DNA is known as the plasmid is the main reason behind the generation of antimicrobial resistant strains. Once the strain is produced, the resistance nature further can be passed to other gonococci bacteria by a method which is known as bacterial transformation. As the antimicrobials used for other diseases are also useful for Gonorrhoea and Gonococci bacteria can easily get the resistance gene from other bacteria, gonorrhoea becomes resistance relatively quickly. Even, if an antimicrobial agent is not used or withdrawal happened during the treatment procedure, Gonorrhoea can still be able to carry the resistance gene for the long time span.
How to monitor the drug-resistant strain?
To look for the global changes in the drug-resistant behaviour of Neisseria gonorrhoea, WHO has initiated a program which is known as GASP or Global Gonococcal Antimicrobial Surveillance Programme? Under this program, according to GASP data it has been found that within the time frame of 5 years (2009-2014), in 97 countries drug-resistant strains generated against the drug ciprofloxacin, a widely used medication as well as against drug azithromycin. As a last resource, antibiotic cefixime is being used for the pathogenic infection treatment. But resistance against this particular drug also gets recorded for nearly 50 countries. In this situation WHO has recommended the use of antibiotics cephalosporins like ceftriaxone and azithromycin in Gonorrhoea infection since 2016.
Is there any new drug available?
The development of new medication for Gonorrhoea is relatively absent. Until now, only 3 new drugs have been developed and have reached different stages of clinical trials. Among these 3 drugs, solithromycin and gepotidacin have approached only until stage II trial. These low numbers if new drugs result from the fact that companies producing antibiotics commercially are not interested in generates medicine for Gonorrhoea infection. Secondly, the new microbial agents will only work for the low amount of time and eventually, resistance will develop making the new drug non-applicable. To address this issue, WHO also launched an initiative altogether with The Drugs for Neglected Diseases initiative, which is known as GARDP or Global Antibiotic Research and Development Partnership. Under the initiative of GARDP, new antibiotics will be developed for the treatment of Gonococcal disease.
Surveillance for Gonorrhoea
Mostly in the USA, resistant strain surveillance is performed through many programs like GISP or Gonococcal Isolate Surveillance Project, eGISP or the enhanced Gonococcal Isolate Surveillance Project. WHO launches a GASP program through which a worldwide laboratory network is maintained for Gonorrhoea infection? WHO GASP program performed several functions like-
- Extensive antimicrobial surveillance so that all countries should follow a treatment guideline.
- To identify the individual with Gonorrhoea infection more rapidly. Additionally, the individual who has undergone a treatment failure takes place.
- To provide clinical support also to partners of the infected individuals.
Identification of Gonorrhoea
There are several options available to detect the presence of Gonorrhoea. Such as-
- NAA or nucleic acid amplification- these particular methods identify the presence of Gonorrhoea DNA or the genetic material in the sample.
- Urine sample- Fars catch urine sample is mostly used to detect the presence of the pathogen.
- Swab culture-samples was taken from infected areas like vagina, rectum or throat
- Blood identification- Once Gonorrhoea presence inside blood, specific antibodies are produced against this particular pathogen. A blood test can be used to identify the presence of those specific antibodies in patient sample.
Can we prevent Gonorrhoea?
The main way to prevent Gonorrhoea infection is the practice of safe-sex which can be achieved mainly by providing information, education and clear communications. All these resources will increase the understanding of individual people towards gonorrhoea or any other STDs.
Gonorrhoea mostly does not show any symptoms and there is also no rapid, point-of-care treatment option availed for such infection. Additionally, most of the patient remains undiagnosed due to lack of observable characteristic. On the other hand, symptoms like vaginal or urethral discharge might be treated as Gonorrhoea, while those symptoms could also be indicative of other STDs, Thus to prevent further spread of Gonorrhoea, we require to concentrate on areas such as-
- Early diagnosis
- Better treatment options.
- Use of antibiotic
- Information on prior infection
- Antibiotic resistance.