Fresh warning on gonorrhoea

Dar es Salaam. Gonorrhoea, one of the sexually-transmitted infections (STIs) known to affect many people in Tanzania, is becoming much harder, and sometimes impossible to treat, a latest report by the World Health Organisation (WHO) has warned.

Experts from the WHO are warning of the decreasing condom use as a preventive measure among the people, the increasing urbanisation and travel as well as poor detection of the infection, but above all—the inadequate or failed treatment of the STI.

The report issued Thursday revealed widespread resistance to older and cheaper antibiotics but the warning comes as an additional voice to the concerns already raised by Tanzanian scientists on the treatment of gonorrhoea and other STIs.

A study done in Mwanza and published in the Southern African Journal of Epidemiology and Infection, partly warned that drug resistance of the Nisseriae gonorrhoeae bacterium to ciprofloxacin antibiotic was “very high.” The researchers used the words, “very high.”

The study, carried out by scientists from the National Institute for Medical Research (Nimr) and Muhimbili University of Health and Allied Sciences (Muhas), called for immediate review of the guidelines on its use as a first-line treatment for STIs in Tanzania.

“Following a sensitivity test, 21 out of 27 (77.7 per cent) of gonococcal isolates were quinolone-resistant to N. gonorrhoeae. One isolate was resistant to ciprofloxacin, azithromycin and cefixime, but not ceftriaxone,’’ the study published online in 2015 reads in part.

“A high prevalence of bacterial vaginosis, gonorrhoea, trichomoniasis, chlamydia and vaginal candidiasis in women who attended the STI clinics in Mwanza was observed,’’ shows the study titled: Genital tract infections in women attending sexually transmitted infection clinics in Mwanza, north-west Tanzania.

However, early in April this year, the Tanzanian government launched the National Action Plan to curb the rising trend of antibiotic resistance.

Chief Medical Officer Prof Mohammed Kambi said the National Action Plan to curb antibiotic resistance would involve experts on animal medicine, the Tanzania Food and Drugs Authority (TFDA), the pharmaceutical authorities and all health stakeholders in the country.

“It (the action plan) will also address the behavioural, legal and social implications of bacterial resistance,’’ he said at the launch in Dar es Salaam.

WHO report issued on Thursday used data from 77 countries around the world, which showed that the trend of antibiotic resistance was raising serious public health concerns.

According to WHO’s head of Human Reproduction, Dr Teodora Wi, the cases of resistance which have been noted, may just be the tip of the iceberg.

“[This is because]…systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common,” said Dr Wi.

Dr Wi explained: “The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”

Each year, an estimated 78 million people are infected with gonorrhoea. The disease can infect the genitals, rectum, and throat, experts say.

Complications of gonorrhoea disproportionally affect women, including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV.

The data from the WHO’s monitoring agencies—collected from 2009 to 2014—found widespread resistance to ciprofloxacin (97 per cent of countries that reported data in that period found drug-resistant strains).

There was increasing resistance to azithromycin (81 per cent); and the emergence of resistance to the current last-resort treatment: the extended-spectrum cephalosporin (ESCs) oral cefixime or injectable ceftriaxone (66 per cent of the countries).

As a result, WHO issued updated global treatment recommendations in 2016 advising doctors to give 2 antibiotics: ceftriaxone and azithromycin.

According to Dr Marc Sprenger, the director of Antimicrobial Resistance at WHO, there is an urgent need for new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests—ideally, ones that can predict which antibiotics will work on that particular infection—and longer term, a vaccine to prevent gonorrhoea. He said, “To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures.”