Gonorrhea has affected humans for centuries and remains common sexually transmitted Infection Worldwide, an estimated 106.1 million cases occur annually, Gonorrhea disproportionately affects racial, ethnic, and sexual minorities. Untreated gonococcal infection can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women and can facilitate transmission of human immunodeficiency virus. Childhood blindness still affects infants born to mothers infected with gonorrhea, particularly in resource-limited countries. In India like many in underdeveloped countries infected with sexually transmitted infection, primary consult the less qualified and many illiterate people approach to quacks, who experiment with least effective and sub optimal doses of the best options and making the bacteria venerable to drug resistance. We have few laboratories which try culturing for Gonorrheal infections, to any one’s surprise few patients attend a teaching hospital before exhausting the available new generation of antibiotics, many who chosen the topic of Gonorrhea find very difficult to isolate on the available media leave the topic as the growth of the organism is certainly difficult and a matter of happening Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. The emergence of cephalosporin-resistant gonorrhea would significantly complicate our ability to treat gonorrhea successfully, since we have few antibiotic options left that are simple, well-studied, and highly effective. It is critical to continuously monitor antibiotic resistance in Neisseria gonorrhea and encourage research and development of new treatment regimens. Cephalosporins continue to be newer options in treating emerging drug resistant strain in Gonorrhea. Trends in Declining Effectiveness cephalosporins, considering the proportion of samples with elevated “minimum inhibitory concentrations” (MICs) of Cefixime and ceftriaxone, recent analyses indicate that higher concentrations of cephalosporins are increasingly needed to stop the bacteria’s growth in laboratory tests. An MIC is the lowest concentration of antibiotics needed to stop the bacteria’s growth in the laboratory. The most significant change in the new guidelines is that CDC no longer recommends Cefixime as an effective oral treatment for gonorrhea, leaving only inject able ceftriaxone to be used in combination with one of two oral antibiotics, either azithromycin or doxycycline. Ceftriaxone is more potent against gonorrhea than Cefixime, and when paired with the additional oral antibiotic, might slow the emergence of drug resistance by ensuring that gonococcal infections are quickly cured and not allowed to spread. The newer research proves that that we are in need of regimes if the trends raise with resistance to ceftriaxone. Two new antibiotic regimens using existing drugs – inject able gentamicin in combination with oral azithromycin and oral Gemifloxacin in combination with oral azithromycin – successfully treated gonorrhea infections in a clinical trial. The trial was conducted by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The study was conducted to identify new treatment options in the face of growing antibiotic resistance. CDC still recommends only one first-line treatment regimen: inject able ceftriaxone, in combination with one of two other oral antibiotics, either azithromycin or doxycycline. This regimen remains highly effective in treating gonorrhea and causes limited side effects. However, providers may consider using the regimens studied in this trial as alternative options when ceftriaxone cannot be used, such as in the case of a severe allergy. CDC is taking the findings of this trial into consideration for inclusion in future treatment guidelines. In the developing countries many are venerable to Gonorrhoea in view of lack of sex education and social support related to STD, it remains critical for people to take steps to protect themselves from gonorrhea infection. The surest way to prevent infection is not having sex. For those who are sexually active, consistent and correct condom use and limiting the number of sex partners can help reduce the risk of infection. (As per CDC guidelines)
MOLECULAR METHODS IN DIAGNOSIS - NAH, nucleic acid amplification test (NAAT) and multiplex PCR. Results are available in <24 above="" addition="" also="" and="" be="" br="" can="" endocervical="" even="" females.="" for="" h.="" having="" heterosexual="" in="" include="" males="" may="" men="" msm="" naat.="" or="" oropharyngeal="" rectal="" sex="" specimens="" swab="" swabs="" the="" to="" urethral="" urine="" used.="" used="" vaginal="" with="">The sensitivity of NAAT (95%), is superior to culture, especially for rectal and pharyngeal swabs, but specificity is less. Only NAAT for urethral swab is presently Food and Drug Administration (FDA), USA approved. And culture is the only method for antimicrobial susceptibility with many challenges in the resource poor laboratories.
WHAT WHO RECOMMENDS - Development of new drugs
The R&D pipeline for gonorrhoea is relatively empty, with only 3 new candidate drugs in various stages of clinical development: solithromycin, for which a phase III trial has recently been completed; zoliflodacin, which has completed a phase II trial; and gepotidacin, which has also completed a phase II trial.
The development of new antibiotics is not very attractive for commercial pharmaceutical companies. Treatments are taken only for short periods of time (unlike medicines for chronic diseases) and they become less effective as resistance develops, meaning that the supply of new drugs constantly needs to be replenished.
References -! Antibiotic-resistant gonorrhoea on the rise, new drugs needed 7 JULY 2017 | GENEVA
2- Molecular methods in the laboratory diagnosis of sexually transmitted infections Sumathi Muralidhar Indian J Sex Transm Dis. 2015 Jan-Jun; 36(1):
3 Current resources from CDC on Sexually transmitted infections
Updated Article by Dr.T.V.Rao MD