Combatting Gonorrhea: Strategies to Tackle Rising STI Cases & Antimicrobial Resistance

United States: Refraining from sexual activity is advocated as “the sole method to entirely evade Sexually Transmitted Infections (STIs),” as advised by public health entities. Refrain from engaging in any vaginal, anal, or oral intercourse.

This counsel is sobering indeed. Yet, it aligns seamlessly with the latest data unveiled by the European Centre for Disease Prevention and Control (ECDC) concerning the dissemination of gonorrhea, a bacterial STI, and the surge in antimicrobial resistance (AMR), as reported by dw.com.

Traditional medical treatments for gonorrhea, such as azithromycin, ceftriaxone, and cefixime, are commonly employed. However, their efficacy is waning progressively. This phenomenon potentially fuels the escalation of gonorrhea cases in Europe, if not globally, along with STIs in a broader sense.

According to a report released by the ECDC on June 10, 2024, the aggregate number of confirmed gonorrhea cases across 28 EU/EEA (European Union/European Economic Area) nations surged to 70,881 in 2022 — marking a 48% surge compared to the previous year.

AMR constitutes a pivotal reason behind the dwindling efficacy of antibiotics, spanning various medical applications — be it STIs or alleviating an earache. Either antibiotics are administered excessively, or the prescribed course is not completed, fostering the proliferation of bacterial resistance to many erstwhile dependable drugs spanning the past century, as per dw.com.

What is gonorrhea?

Gonorrhea is attributable to the Neisseria gonorrhea bacterium, manifesting in the genitalia, rectum, and/or throat. Predominantly prevalent among individuals aged 15-24 years.

Symptoms in women frequently evade detection, and when present, they typically manifest mildly, often mimicking symptoms of alternate vaginal or bladder afflictions — heightened risk for women ensues due to the diagnostic challenges. Particularly concerning is the risk posed to pregnant women, as STI infections can be transmitted to the fetus. Prenatal complications may ensue due to undetected STIs, potentially leading to infertility.

In contrast, men typically exhibit symptoms, including a stinging sensation during urination, discharge of white, yellow, or green hue, and/or discomfort or swelling of the testes.

“However, such manifestations are less commonplace in men. Prioritizing women is imperative, given their propensity for asymptomatic presentations,” asserted Teodora Elvira Wi, spearheading global HIV, hepatitis, and STI programs at the World Health Organization headquarters in Geneva.

“We necessitate avenues for women to undergo STI screening, particularly those at heightened risk, including individuals with multiple partners and sexually active adolescents,” Wi emphasized as highlighted by dw.com.

Antimicrobial resistance poses “concerning” challenge in combating common antibiotics for gonorrhea

The ECDC report undertook an analysis of 4,396 samples (termed “isolates”) of gonorrhea procured from 23 countries in 2022.

The findings revealed a noteworthy surge in isolates exhibiting resistance to azithromycin, escalating to 25.6%, compared to 14.2% in 2021.

Given that azithromycin is often paired with ceftriaxone, this revelation elicited particular concern from the ECDC.

While resistance to ciprofloxacin witnessed an uptick, albeit not as pronounced — 65.9% of isolates showcased resistance in 2022, up from 62.8% in 2021.

Resistance to cefixime remained “insignificant at 0.3%.”

Collectively, the ECDC’s data is echoed in findings from other regions worldwide, including Africa and Asia, as per the World Health Organization, dw.com highlighted.

“Antimicrobial resistance constitutes merely one contributing factor [there]. However, in regions where antimicrobial resistance surpasses that in Europe, it accentuates the surge in bacterial STIs,” Wi remarked, highlighting that globally, 73 countries have furnished data on antimicrobial resistance in gonorrhea.

The ECDC’s data depicted an upsurge in pharyngeal gonorrhea instances, while cases of genital and anorectal gonorrhea remained stable throughout 2022.

Strategies to curb the proliferation of STIs

Global data from the World Health Organization in 2020 documented 374 million fresh cases annually of syphilis, gonorrhea, chlamydia, and trichomoniasis among individuals aged 15-49 years. The WHO identified several factors driving the escalating incidence of STIs:

  • Escalation in unsafe sexual practices, encompassing diminished condom usage, escalation in the number of sexual partners, and engagement in casual liaisons
  • Prevalence of asymptomatic infections and the influence of socioeconomic factors; biological determinants
  • Inadequate access to STI services, deficiency in STI services, and dearth of diagnostic tools attributable to underinvestment in services
  • Stigmatization: STI sufferers forgo seeking care, exacerbating the dearth of funding for STI services and research endeavors
  • Mitigating and/or reversing these factors represents a prudent outset in public health initiatives aimed at curbing the prevalence of STIs.

However, Wi advocates against complete abstinence from sexual activity — rather, she underscores the importance of sexual education. “Engage in sexual activity, derive pleasure from it, approach it consensually, prioritize your sexual well-being, and safeguard yourself as you would against other infections,” she urged.

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