'Highly resistant' gonorrhea on the rise in Canada, other countries: World Health Organization

Several countries, including Canada, are seeing a spike in cases of gonorrhea that are “highly resistant” to existing treatments, according to the World Health Organization’s most recent guidance regarding sexually transmitted infections.

The World Health Organization (WHO) shared the warning in a news release Monday regarding their latest guidelines for testing for and diagnosing sexually transmitted infections (STIs).

According to the organization, the COVID-19 pandemic caused disruptions to prevention, testing and treatment services for STIs in many countries, leaving them battling a new resurgence of these infections now – and the spectre of antimicrobial resistance is making these infections harder to kick than ever.

“Of concern, the spread of a Neisseria gonorrhea clone that is highly resistant to ceftriaxone is increasingly being reported in countries in Asia such as China, Japan, Singapore and Vietnam as well as in Australia, Austria, Canada, Denmark, France, Ireland and the United Kingdom,” the release stated.

“The enhanced gonorrhea AMR surveillance (EGASP) suggests high rates of resistance in gonorrheae to current treatment options such as ceftriaxone, cefixime and azithromycin in Cambodia, for instance.”

Gonorrhea is an STI that is caused by infection with the Neisseria gonorrheae bacterium, which infects the mucus membranes of the reproductive tract, or of the mouth, throat, eyes or rectum. It is transmitted by sexual contact with the genitals, mouth or anus of an infected partner, or can be spread from an infected mother to their baby during childbirth.

In 2020, WHO estimates that 82 million new infections of gonorrhea occurred worldwide, making it the third most common STI in terms of new infections after trichomoniasis and chlamydia.

According to Statistics Canada, gonorrhea cases in Canada have almost tripled over the past decade, with more than 35,000 cases reported in 2019. Two-thirds of these cases were among men, and more than half were among people less than 30 years of age.

If it goes untreated, gonorrhea can spread to the uterus or fallopian tubes and cause pelvic inflammatory disease, which can include severe abdominal pain and fever and may lead to chronic pelvic pain or even infertility. It can also cause infertility in men in rare cases, according to the U.S. Centres for Disease Control and Prevention, and can increase the risk of a person transmitting or acquiring HIV.

Another uncommon, but severe complication that can arise from gonorrhea going untreated is the infection spreading to the blood and causing a condition called disseminated gonococcal infection (DGI), which can be life-threatening.

There are more than one million STIs acquired every day across the globe, according to WHO, with most of them having no obvious symptoms.

Gonorrhea is one of four common STIs that are considered curable, a list which also includes syphilis, chlamydia and trichomoniasis.

However, increasing antimicrobial resistance is cutting into the effectiveness of treatments for gonorrhea, according to WHO.

Antimicrobial resistance (AMR) is when bacteria, viruses and parasites change to evade medicines, making antimicrobial medications ineffective over time.

“With resistance to both cephalosporins, including third-generation extended spectrum cephalosporins, and fluoroquinolones, N. gonorrheae is a multidrug-resistant pathogen,” a report released with the guidelines states. “Resistance is outpacing new antibiotics for N. gonorrheae.”

The organization stated that the bacterium behind gonorrhea is a “priority microorganism for AMR monitoring in the Global Antimicrobial Surveillance System” and that they are looking to spur development for new drugs to tackle gonorrhea.

“New models of STIs services need to be resilient and adaptive to current and future threats,” Dr. Meg Doherty, Director of WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, said in the release. “Recent scientific advances in STIs treatment and technologies, and innovative service delivery methods, provide an important opportunity to end STIs as a public health concern by 2030. However, large variations in investment, maturity and performance of STI surveillance systems between countries continues to be a challenge”.

According to WHO, gonorrhea isn’t the only STI that is currently posing a difficulty in terms of treatment.

“Syphilis, as well as congenital syphilis, are on the rise, and the lack of benzathine penicillin poses a considerable challenge to effectively treat them,” the release stated.

WHO’s new guidance includes descriptions of what point-of-care tests for syphilis, gonorrhea, chlamydia and trichomonas vaginalis should look like in order to “facilitate development of quality STI diagnostics.”

Point-of-care testing, in general, refers to tests that are performed at or near a patient and at the site where treatment or care is provided. It encompasses tests that can be done simply and provide results relatively quickly, including tests that can be performed by a patient themselves, as opposed to tests that may require highly specialized locations and extended processing at a lab.

“Early testing and diagnosis are key in stopping the spread of STIs. When left untreated, certain STIs can lead to long-term irreversible outcomes and some can be potentially fatal, “Dr. Teodora Wi, Lead for Sexually transmitted infections of the WHO Global HIV, Hepatitis and STIs Programmes, said in the release. “Our new guidance can help make low-cost point of care tests for STIs more accessible, enabling improved data collection and quality delivery of STI services for people in need.”

Gonorrhea often has no symptoms at all, making the implementation of screening and simple tests even more important, experts say.

When there are symptoms, urethral infection in men may include a white, yellow or green discharge appearing one to fourteen days after infection. If the infection is complicated by epididymitis, men may experience testicular pain as well. Symptoms in women are so subtle that they are often mistaken for a bladder or vaginal infection, sure as vaginal discharge or vaginal bleeding between periods.

Rectal infection in all persons can include symptoms of discharge, itching, soreness, bleeding or painful bowel movements, but it can also be asymptomatic.

You can minimize your chances of contracting gonorrhoea by using condoms during sexual activities and limiting your sexual partners, as well as ensuring you get tested regularly. 

The World Health Organization (WHO) is currently sharing its latest guidance on testing for and diagnosing sexually transmitted infections at the STI & HIV 2023 World Congress in Chicago, U.S., which runs from Monday to Thursday.