The rise of multidrug resistance in gonorrhoea-causing bacteria is threatening to make this sexually-transmitted infection extremely difficult to treat. Professor Catherine Ison, speaking at the Society for General Microbiology's spring meeting in Edinburgh, highlighted the very real possibility that strains of Neisseria gonorrhoeae resistant to all current treatment options could emerge in the near future.
Professor Ison, from the Health Protection Agency (HPA) in London, described how some strains of the gonococcal bacteria that cause the disease are now showing decreased sensitivity to the current antibiotics used to treat them - ceftriaxone and cefixime.
Gonorrhoea is the second most common bacterial sexually-transmitted infection and if left untreated can lead to pelvic inflammatory disease, ectopic pregnancy and infertility in women. Current treatment consists of a single dose of antibiotic given in the clinic when prescribed, by mouth for cefixime and by injection for ceftriaxone.
"Choosing an effective antibiotic can be a challenge because the organism that causes gonorrhoea is very versatile and develops resistance to antibiotics very quickly," explained Professor Ison. "Penicillin was used for many years until it was no longer effective and a number of other agents have been used since. The current drugs of choice, 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.
Bacteria isolated from patients diagnosed with gonorrhoea are tested for their susceptibility to various antibiotics to monitor patterns of resistance at a local and national level. Ongoing monitoring of antimicrobial resistance is critical to ensure that first-line treatments for gonorrhoea remain effective. "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," Professor Ison warned. "If this problem isn't addressed then there is a real possibility that gonorrhoea will become a very difficult infection to treat," she said.
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