The bacteria responsible for the sexually transmitted infection gonorrhea are becoming so resistant to antibiotics in some parts of the world, they may soon reach superbug status, experts are warning.
Catherine Ison, a professor at the Health Protection Agency Centre for Infections in London, presented a report this week at the Society for General Microbiology Spring Meeting in Edinburgh, Scotland, discussing the growing problem of antibiotic resistance among gonorrhea.
She highlighted the possibility that strains of Neisseria gonorrhoeae will soon become resistant to all current treatment options.
Ison said some strains of gonorrhea-causing bacteria are now showing decreased sensitivity to the current antibiotics used to treat them: ceftriaxone and cefixime.
"Ceftriaxone and cefixime are still very effective but there are signs that resistance particularly to cefixime is emerging and soon these drugs may not be a good choice," she said in a statement released by the Society for General Microbiology.
She said instances of drug resistance among gonorrhea cases have started to appear in Japan. Other reports of rising gonorrhea drug resistance had also come from Hong Kong, China, Australia and parts of Asia.
In Canada, a report published last year in the Canadian Medical Association Journal, found there had been a sharp increase in the percentage of gonorrhea cases in Ontario that had grown resistant to what were then the most commonly prescribed antibiotics.
The research showed that 28 per cent of gonorrhea samples tested in 2006 were resistant to fluoroquinolone drugs, up from 4 per cent in 2002. In fact, in one unnamed clinic -- identified by the researchers as treating a large clientele of gay men -- fully 55 per cent of samples were quinolone-resistant.
Before the resistance problem developed, fluoroquinolones (such as the antibiotic dubbed Cipro) had been the standard treatment of Neisseria gonorrhea in Canada. When it became apparent that the bacteria had grown resistant to quinolones, public health officials in Canada and the United States told doctors they should no longer use the drugs.
The recommendation then was to switch to a cephalosporin such as cefixime.
Ison now says the best way to try to reduce the risk of drug resistance would be to treat gonorrhea cases with two cephalosporins at the same time.
"There are few new drugs available and so it is probable that the current use of a single dose may soon need to be revised and treatment over several days or with more than one antibiotic will need to be considered," Ison warned.
"If this problem isn't addressed, then there is a real possibility that gonorrhea will become a very difficult infection to treat," she said.
Experts from the World Health Organization are expected to discuss drug-resistant gonorrhea at a meeting in the Philippine capital Manila next week.
Gonorrhea is the second most common bacterial sexually-transmitted infection in the world, though it can be prevented with the diligent use of condoms. If left untreated, the infection can lead to pelvic inflammatory disease, ectopic pregnancy and infertility in women.
Current treatment consists of a single dose of antibiotic, usually given in a clinic, by mouth for cefixime and by injection for ceftriaxone. Ison suggests doctors begin giving both antibiotics at the same time to infected patients.
Dr. Kelly MacDonald, a microbiologist at Mount Sinai Hospital in Toronto, says the reports of drug resistance are worrying given that if doctors have to abandon the cephalosporin class of antibiotics, there will be few other options.
"Our list of new drugs is very short. The new drug development pool is a small puddle now -- we have only a few left. And many can't be used on those who are pregnant or has allergies," she explained to CTV.ca in an interview.
She added that the solution to rises in rates of gonorrhea and other STI infection isn't in finding the perfect antibiotic; it's in fully treating it when it does happen, and preventing infection in the first place.
She notes that public health authorities need to step up effort to promote ondom use, noting that the loud safer sex campaigning during the 1980s following the emergence of HIV had quieted in recent years.
"It's been almost 30 years since we started this messaging. But a whole generation has gone by and the message is getting forgotten," she said.
