Gonorrhea Infections: Alarming Rise in Antibiotic Resistance
Public Health Crisis: Untreatable Gonorrhea Looms
Health officials have long warned that gonorrhea is becoming more and more resistant to all the antibiotic drugs we have to fight it. Recent studies have revealed a grim reality – a sharp increase in the prevalence of drug-resistant strains of Neisseria gonorrhoeae, the bacterium responsible for the infection.
Last year, two unrelated people in Massachusetts were found to have gonorrhea infections with complete or reduced susceptibility to every known drug, including the frontline drug ceftriaxone. Although they were successfully treated with high-dose injections of ceftriaxone, these cases signal a terrifying development. As the US Centers for Disease Control and Prevention (CDC) plainly states, “Little now stands between us and untreatable gonorrhea.”
China Study Reveals an Alarming Surge
A study published by researchers in China further fuels the alarm by reporting a significant rise in ceftriaxone-resistant gonorrhea cases between 2017 and 2021. The study analyzed Neisseria gonorrhoeae bacterial isolates collected from across the country and discovered that the prevalence of ceftriaxone-resistant strains nearly tripled.
In 2022, about 8 percent of the nearly 3,000 bacterial isolates from gonorrhea infections exhibited resistance to ceftriaxone. This marks a staggering increase from under 3 percent resistance reported in 2017. The concerning findings are published in the CDC’s Morbidity and Mortality Weekly Report.
When compared to other countries, China’s ceftriaxone-resistant strain prevalence is disconcertingly high. For the US and Canada, the prevalence remained below 1 percent, barring a few sporadic reports. In 2022, the United Kingdom reported a prevalence of only 0.21 percent.
The Dwindling Options: Ceftriaxone as Last Resort
Why is ceftriaxone the sole viable treatment for gonorrhea? Unfortunately, Neisseria gonorrhoeae has built resistance to numerous antibiotics over the past few decades. In the 1980s, penicillin and tetracycline were effective. However, resistance soon rendered them ineffective. Fluoroquinolones, including ciprofloxacin, became the go-to treatment in the 1990s, only to face widespread resistance.
Since then, the CDC has been forced to continuously adapt treatment recommendations. Early 2000s witnessed the rise of resistance to cephalosporins like cefixime, leading to further revisions in the treatment regimen that combined cephalosporins with antibiotics like azithromycin or doxycycline. But alas, resistance development persisted, resulting in the successive abandonment of such combination therapies, with azithromycin becoming the latest casualty in 2020.
Resistance Rising in China
The China study offers an alarming snapshot of the escalating ceftriaxone-resistance isolates. Of the 2,804 isolates analyzed, ceftriaxone resistance was detected in 8.1 percent. Notably, specific provinces in China reported even higher resistance rates, with some exceeding 25 percent. Additionally, 18 isolates demonstrated resistance to all antibiotics, except for the discontinued spectinomycin.
It’s important to acknowledge the study’s limitations. Reported gonorrhea cases are likely an undercount, as many cases go unreported due to asymptomatic infections. However, the study underlines the pressing need for a comprehensive approach to address antibiotic-resistant N. gonorrhoeae in China. Factors contributing to high resistance rates in affected provinces must be identified to devise effective strategies.
A Global Public Health Concern
This study demands international attention, as the spread of resistant strains extends beyond China’s borders. Cross-border collaboration and monitoring efforts are crucial in mitigating the further spread of these resistant clones. Untreatable gonorrhea would pose dire consequences worldwide.
