A different regimen of antibiotics being tested in the United Kingdom may delay the rise of completely untreatable gonorrhea, but experts in the country warn it's only a temporary measure.
Three cases of "treatment failure" in patients with the sexually transmitted infection have occurred in the United Kingdom, and several other treatment failures have occurred in Japan, Canada, Austria, France and Norway. But, according to Catherine Ison of London's Health Protection Agency, doctors in Wales and England have been able to fight back against rising antibiotic resistance rates by switching to more powerful drugs.
Resistance to cefixime, one of the last effective drugs against the bacteria, was seen in just 1.5 percent of cases in 2007, but jumped to 17 percent of cases by 2010, when health officials in the country decided to change treatment guidelines. A year later, resistance was seen in just 11 percent of cases, perhaps because patients with newly-diagnosed gonorrhea were given a high dose of an injectable antibiotic called ceftriaxone combined with a second antibiotic known as azithromycin.
"We know that the prescribing practice changed very quickly and the bacteria that have [antibiotic resistance] seem to be decreasing for now," Ison says. "But to be absolutely clear, this is just buying time, this is not a solution."
Untreatable gonorrhea is a near certainty in the future, according to Ison. Major health organizations worldwide have been warning as much for several years now: In February 2012, the Centers for Disease Control said in the New England Journal of Medicine that it's time to "sound the alarm" about the possibility of incurable gonorrhea. The World Health Organization followed suit in June 2012. In January, a study in the Journal of the American Medical Association described the first cases of antibiotic-resistant gonorrhea in North America.
At the time, Manjula Lusti-Narasimhan, of WHO's department of reproductive health and research, told U.S. News that "we're sitting on the edge of a worldwide crisis" and said the disease may soon be just as incurable as HIV.
Ison says it's only a matter of time until antibiotic resistance in gonorrhea increases in cefixime and ceftriaxone, and very few new antibiotics are in the works to replace them. According to Ison's study, published Monday in The Lancet, there are "no obvious reserve treatments available for gonorrhea … these setbacks raise the real possibility that gonorrhea could become difficult to treat or untreatable."
"I'd be very surprised if we don't need another treatment strategy very soon ... one would like to think that we're buying time for increased prevention measures and for companies to make new drugs," she says. "This bacteria always develops new resistances and we already know it's developing resistance to cefixime."
In Britain, resistant strains of gonorrhea were most often found in gay men and people who are HIV-positive. Resistant strains were less often found in women. Ison says that's likely because the gay community in the United Kingdom is a "relatively closed group," so resistant strains of the bacteria are being passed around. In other European countries, there is less of a disparity between the prevalence of antibiotic-resistant strains found in women and men.
"I don't think we have any real evidence to show that it would only infect those in the [gay] community," she says.