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WHO suggests new treatment for gonorrhea as antibiotic resistance rises

Ben Schmitt
| Tuesday, Aug. 30, 2016, 4:15 p.m.

The sexually transmitted disease gonorrhea continues to develop strong resistance to antibiotics to the point where the World Health Organization released treatment guidelines Tuesday calling for different medication.

Because of widespread resistance, older and cheaper antibiotics are no longer effective in treating the infection, the WHO said in a statement.

Gonorrhea infects an estimated 78 million people every year. Although many suffer no symptoms, the bacterium can cause pain in the genitals, rectum and throat, and can lead to infertility and infections of the brain or the heart if untreated.

“The growing threat of antimicrobial resistance encompasses all infectious diseases, and one area in which it is especially important is the realm of sexually transmitted infections,” Dr. Amesh Adalja, an infectious disease specialist and senior associate at the UPMC Center for Health Security, told the Tribune-Review. “The specter of totally drug-resistant gonorrhea is among the most frightening scenarios identified by the Centers for Disease Control and Prevention.”

The WHO guidelines, dating to 2003, recommended treating gonorrhea infections with antibiotics known as quinolones, such as ciprofloxacin. But resistant strains of the bacterium have spread across the globe, says Teodora Wi, a WHO medical officer. She called gonorrhea a “very smart bug” that repeatedly adapts to new antibiotics.

Dr. Harold Wiesenfeld, medical director of the STD program at the Allegheny County Health Department, agreed that gonorrhea is adept at fending off antibiotic treatments.

He said WHO guidelines piggyback on previous CDC recommendations that doctors treat the infection with a combination of antibiotics known as ceftriaxone and azithromycin. One is injected, and the other is taken orally.

“This report is important because it further highlights the concern in the field of resurgent STD care that we are running out of treatments in gonorrhea,” said Wiesenfeld, who is also an infectious disease specialist at Magee-Womens Hospital of UPMC. “We are already seeing a creep in declining susceptibility. If the current standard treatment doesn't work, we have few options left, and the options are either expensive or more challenging to administer.”

Dr. Tom Walsh, who works as Allegheny General Hospital's medical director of the antimicrobial stewardship program, said drug development is necessary in the battle against gonorrhea.

“Once it becomes resistant, it doesn't revert back to becoming susceptible in almost all cases,” he said. “It's going to continue to acquire more antimicrobial resistance. Hopefully, this will assist with ramping up education and reporting treatment failure to local and state health departments.”

The organization updated treatment guidelines for chlamydia and syphilis, which, combined with gonorrhea, infect more than 200 million people annually.

“The new WHO guidelines reinforce the need to treat these sexually transmitted infections with the right antibiotic, at the right dose, and the right time to reduce their spread and improve sexual and reproductive health,” Ian Askew, director of reproductive health and research for WHO, said in a statement. “To do that, national health services need to monitor the patterns of antibiotic resistance in these infections within their countries.”

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991 or bschmitt@tribweb.com. The Associated Press contributed.

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