Gonorrhea is evolving into a scourge resistant to most antibiotics, and urgent action is needed to combat this public health threat, states an editorial in CMAJ.
Gonorrhea, a sexually transmitted disease (STD) that causes pelvic inflammatory disease and urethritis, is evolving into multiresistant bacteria because most treatments are now ineffective. Japan reported the first example of multiresistant gonorrhea. Neisseria gonorrhea, the organism responsible, can mutate rapidly and has a complex biology that has foiled attempts to develop a vaccine. It can also promote antibiotic resistance in other microbes through gene transfer.
Targeted approaches aimed at high-risk groups, such as sexually active young people, can help stop the spread of gonorrhea. Creative and humorous public education campaigns, such as Alberta's www.plentyofsyph.com campaign against STDs, which resulted in a 15% to 20% increase in testing in its first month, are a start. Access to testing and care must be made easier, and emphasis on safe sex and condom use is crucial.
"The spectre of widespread multiresistant gonorrhea demands an urgent public health, community and individual response," conclude the authors. "Without action, we are heading back to the pre-antibiotic era, with an escalation in the number of deaths from other multiresistant organisms as well as rampant gonococcal infections -- with treatment options for urethritis limited to painkillers, baths and catheterization for strictures."
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