WHO suggests new treatment for bacterial STDs as antibiotic resistance rises

The World Health Organisation (WHO) on August 30 released a new set of guidelines for the treatment of three common sexually transmitted diseases (STDs) in response to their growing threat of antibiotic resistance. 
Chlamydia, gonorrhoea and syphilis are all caused by bacteria and are generally curable with antibiotics. However, these STDs often go undiagnosed and are becoming more difficult to treat, with some antibiotics now failing as a result of misuse and overuse. It is estimated that, each year, 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis.

Resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STDs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.

Graphic Source: World Health Organisation

When left undiagnosed and untreated, these STIs can result in serious complications and long-term health problems for women, such as pelvic inflammatory disease, ectopic pregnancy, and miscarriage, and untreated gonorrhoea and chlamydia can cause infertility in both men and women. Infection with chlamydia, gonorrhoea and syphilis can also increase a person’s risk of being infected with HIV two- to three-fold. An untreated STI in a pregnant woman increases the chances of stillbirth and newborn death.

The new recommendations are based on the latest available evidence on the most effective treatments for these 3 sexually transmitted infections.

Gonorrhoea

Gonorrhoea usually infects the genitals, rectum, and throat. Antimicrobial resistance has appeared and expanded with every release of new classes of antibiotics for the treatment of gonorrhoea. Because of widespread resistance, older and cheaper antibiotics have lost their effectiveness in treatment of the infection.
In its release, the WHO does not recommend quinolones (a class of antibiotic) for the treatment of gonorrhoea due to widespread high levels of resistance.

Syphilis

Syphilis is spread by contact with a sore on the genitals, anus, rectum, lips or mouth, or from mother to child during pregnancy. If a pregnant woman has untreated syphilis and the infection is transmitted to the fetus, this often causes it to die. In 2012, mother-to-child transmission of syphilis resulted in an estimated 143 000 early fetal deaths or stillbirths, 62 000 neonatal deaths, and 44 000 babies being born preterm or with low-birth-weight.

To cure syphilis, the new WHO guidelines strongly recommend a single dose of benzathine penicillin – a form of the antibiotic that is injected by a doctor or nurse into the infected patient’s buttock or thigh muscle. This is the most effective treatment for syphilis, as it is more effective and cheaper than oral antibiotics.

Chlamydia

Chlamydia is the most common bacterial STD and people with this infection are frequently co-infected with gonorrhoea. Symptoms of chlamydia include discharge and a burning feeling when urinating, but most people who are infected have no symptoms. Even when chlamydia is asymptomatic, it can damage the reproductive system.

WHO is calling on countries to start using the updated guidelines immediately, as recommended in the "Global Health Sector Strategy for Sexually Transmitted Infections (2016-2021)" endorsed by governments at the World Health Assembly in May 2016. The new guidelines are also in-line with the "Global Action Plan on Antimicrobial Resistance", adopted by governments at the World Health Assembly in May 2015.