The news only gets worse when it comes to drug-resistant gonorrhea.
New data from the World Health Organization suggest the sexually transmitted bacterium, which has learned to withstand almost all the antibiotics available to cure it, is making more progress in its relentless march toward untreatable status.
The current recommended regimen for gonorrhea is a combination of two antibiotics, azithromycin, which comes in pill form, and ceftriaxone, which is injected.
Global surveillance data compiled by the WHO show that 66 percent of reporting countries had seen gonorrhea strains that were either resistant to or displayed reduced susceptibility to ceftriaxone in at least one year between 2009 and 2014. And 81 percent of the reporting countries saw strains that were either resistant to or had reduced susceptibility to azithromycin.
The real-world picture is undoubtedly bleaker, acknowledged Dr. Teodora Wi, a medical officer in the WHO’s department of reproductive health and research. That’s because global surveillance for drug-resistant gonorrhea is spotty, and is done more commonly in affluent countries than in low-income countries.
The report included data from only 77 countries. Most African nations — and the rate of gonorrhea is high in parts of Africa — did not report.
“If high-income countries are able to detect it … then there are more cases of untreatable gonorrhea in most of these countries and they are not really being documented at this point,” Wi said.
To date, doctors in Japan, Spain, and France have reported individual cases in which they were unable to cure gonorrhea infections. But in at least one case the patient did not return for further follow-up, and it’s unclear what his or her status is, Wi said.
Doctors who work in this field have warned for years that it’s only a matter of time before the current recommended treatment begins to fail on a regular basis. At the moment, there is no alternative treatment.
“The news is looking a little bit grim. We need to get our act together and we need to get moving,” said Dr. Manica Balasegaram, director of the Global Antibiotic Research and Development Partnership, which is working to accelerate testing and development of antibiotics that might work for gonorrhea but are still experimental.
The need for new options is huge. An estimated 78 million people a year are infected with gonorrhea. There is currently no vaccine and people who have been cured can be reinfected.
In the early days of the AIDS epidemic, rates of gonorrhea and other sexually transmitted infections tumbled, because fear of the disease spurred more people to use condoms and practice other forms of safer sex.
But those good habits started to fall by the wayside when antiretroviral drugs became available and HIV infection became more of a chronic condition than a killer.
Gonorrhea is particularly insidious, because it has been so successful at evolving to evade the antibiotics prescribed to treat it. While women may experience lower abdominal pain and men a burning sensation during urination, for some people the infection is virtually symptom-free.
Over time, untreated gonorrhea can lead to infertility and increase the risk that an infected person will contract HIV. Babies born to a woman who is infected can develop blindness as a consequence of contracting the bacteria.
“In a few years there is going to be resistance to the last-line treatment, and we know that drug development takes years. So we need to prepare for this imminent resistance to treatment,” Wi said. “If we don’t have treatment for gonorrhea, we will have very serious consequences.”
Some countries are already increasing the doses of the recommended drugs, to try to overcome the bacteria’s resistance, she said.
The WHO data were published Thursday in the journal PLOS Medicine, along with an article laying out the steps being taken and the research required to address the growing problem.
Better and more affordable tests are needed, the authors of the second paper noted. The rapid diagnostics currently used in clinics and doctors’ offices will indicate if a person is infected, but generally cannot tell if his or her strain is resistant to the recommended treatment.
A vaccine would be a game-changer, but so far this goal has eluded scientists. Old antibiotics that haven’t been commonly used — some because they can cause serious side effects — should also be tested to see if they are effective against gonorrhea, Balasegaram said. “It’s something that’s worth trying,” he said. “May or may not work.”
The organization he heads is working with a group called DNDi — Drugs for Neglected Tropical Diseases Initiative — to try to help experimental drugs speed their way to the market.
On Thursday, they announced a deal with a Boston-based biotech company called Entasis Therapeutics, which is developing one such drug, called zoliflodacin.
As part of the deal, the company will grant the Global Antibiotic Research and Development Partnership an exclusive license to the drug in more than 160 low- and middle-income countries; Entasis will retain the license for high-income countries.
This agreement will allow GARDP to sub-license production to pharmaceutical companies in low-income countries, ensuring that it is available to these countries at an affordable price.
In exchange, the group — which is operating as part of DNDi — will help the company conduct the Phase 3 clinical trial it needs to apply to bring the drug to market, as well as other needed trials. Balasegaram said the hope is the drug will hit the market by late 2020.
Still, there are no sure bets in drug development, he acknowledged. “There are only three drug candidates in the entire antibiotic pipeline for gonorrhea, with obviously no guarantees that these drugs may make it out of the pipeline,” he said. “So the situation is actually fairly grim.”
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