Case of untreatable gonorrhea

Having a sexually transmitted infection is a bad enough experience on its own. Usually though, it is nothing that a treatment course from your doctor won’t help clear off. Then you promise yourself to be more careful in the future. But then, the disease causing microorganisms are evolving too and, thanks to this turns into what scientists call untreatable gonorrhea. Super gonorrhea, others call it. And it is on the rise, right here in Africa.

But hold on, before we explore this superbug, let’s examine a few facts. Gonorrhea is the most common sexually transmitted disease.

The World Health Organization (WHO) approximates that 11.4 million gonorrhea cases occur annually in the African region and warns of the emerging threat of “untreatable” gonorrhea. Those of us in public health and healthcare sector understand quite clearly that gonorrhea is quite a stubborn disease.

How the superbug developed

Caused by a bacterium known as Neisseria gonorrhea, the disease has notoriously developed resistance to outsmart the class of antibiotics used to treat it. The new resistant strains are reported to be as a result of inter-species recombination of genes between the main causative bacterial agent, N. gonorrhea and other commensal strains of the same genus. This alarming recombination continues to stress the already dwindling treatment options and the WHO is concerned about a near future with a superbug that causes untreatable gonorrhea. The bug infects the cervix, uterus and oviducts (Fallopian tubes) in women and urethra in both men and women. It can also cause infection in the eyes, mouth, throat and rectum.

How do you get it?

Sexual contact is the main mode of transmission of gonorrhea. Either through the penis, vagina, mouth or anus, an infected partner can pass it along. For a man, no ejaculation is needed for you to transmit or acquire it. In addition, infection does not guarantee immunity. That means, one can be re-infected even after they had previously had successful treatment against gonorrhea. Infected mothers can also pass it to their babies during childbirth.

Why you should be worried

The absence of a vaccine for preventive purposes makes us rely on antibiotics as the only means of managing gonorrhea. In Kisumu, between 2000 and 2010, there was a 50 per cent increase in resistance of gonorrhea to ciprofloxacin, a drug that was previously used to treat it. This is according to a research done on antibiotic resistance in gonorrhea in people living in Kisumu.

Ciprofloxacin belongs to a class of antibiotics known as fluoroquinolones. After reporting fluoroquinolone resistance in western Kenya in 2009, the coast region in 2011 and in Nairobi in 2012, the national treatment guidelines for treatment of gonorrhea were revised to include a class of antibiotics called cephalosporins. Even though adherence to medication will treat the infection, it will not restore any permanent damage caused by the infection.

Origin of the antibiotic resistant strain

A study published in the Oxford Academic Journal of Antimicrobial Chemotherapy showed that antimicrobial resistance developed first in the WHO Western Pacific Region (which includes China) then followed by international spread. A survey by Kenyan scientists done in a period of four years, from 2012 to 2015 in Nairobi found out that ceftriaxone was still a useful antibiotic in the treatment of gonorrhea. Other antibiotics that were still shown to be useful include cefixime, spectinomycin, and azithromycin.

Majority of both men and women with gonorrhea are asymptomatic. In men, symptoms include:

A white, yellow or green urethral discharge Pain when urinating Scrotal and testicular pain.

In women, symptoms are sometimes mistaken for vaginal or bladder infection. Most women experience:

Increased vaginal discharge Pain when urinating Bleeding between periods.

In both men and women, rectal infection may manifest through:

Itching Painful bowel movements Soreness and bleeding Sometimes one could develop a sore throat

Permanent health problems associated with stubborn gonorrhea

Gonorrhea infections are painful. Pelvic inflammatory disease (PID) in women can occur with infection that spreads out into the uterus or fallopian tubes.

PID subsequently causes chronic pelvic pain, damaged fallopian tubes which is enough to increase the risk of ectopic pregnancy and infertility.

In men, untreated gonorrhea is also associated with infertility.

When gonorrhea spreads into the blood, it can cause a life threatening condition known as disseminated gonococcal infection (DGI). This is a condition characterised by arthritis and tenosynovitis. It also increases one’s risk of transmitting or acquiring HIV.

What increases the risk to gonorrhea infection?

Lack of or incorrect use of barrier protection in sexual exposure with an infected partner Male homosexuality Multiple sex partners

Dr Supriya Mehta advises on the use of region specific guidelines for the management of the disease. “Many countries have treatment guidelines for gonorrhea, but they need to be specific to local epidemiology and microbiology.”

When diagnosed with gonorrhea, furnish your doctor with adequate sexual history to avoid treatment failure and foster effective treatment of asymptomatic patients. A sexually active man who has sex with men or is bisexual should go for gonorrhea screening every year. So is a sexually active woman, young or old, who has multiple sex partners or a partner who has an STI.

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