According to Whiley et al. (2012) in their article “The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting,” the recent isolation of F89 and H041 Neisseria gonorrhea strains in Japan and France, respectively, underscores the urgency of finding a solution to drug resistant disease. F89 and H041 are extensively drug resistant. The gonococcus has developed resistance to several classes of antibiotics such as penicillins, macrolides, tetracyclines, and quinolones as well as the newly observed resistance to extended-spectrum cephalosporins (ESCs). The real challenge is that given the history of the bacterium’s drug resistance, the strategies currently in use may become reprieves in the near future, rather than solutions. This problem, therefore, demands urgent action at all levels – local and international. The author’s recommend increased research, surveillance and vaccine development as steps towards handling this challenge. Furthermore, dual therapy regimens are encouraged, such as used in the UK and USA; the adoption of dual therapies wherever possible can help slow the development of drug resistance. Finally, up-to-date information on Neisseria gonorrhoeae can help towards the development of effective control policies. Such surveillance needs to be optimized based on the country or population targeted.
Nearly 20 million new infections of sexually transmitted diseases are recorded annually in the United States. Fanfair and Workowski (2014) further state that the closing of STD and HIV clinics due to state budget cuts (based on the passage of the Affordable Care Act) means that more primary care providers will be seeing more STD patients. STD infections have long-term consequences for infants and women including HIV facilitation, cancer in the reproductive tract, infertility, poor perinatal outcomes and pelvic inflammatory disease. Screening, surveillance, partner management and treatment constitute traditional prevention and control strategies for STDs. However, there is need for timely diagnosis. STD prevalence is higher among some groups such as sexually active younger people, racial and ethnic minorities, homosexual men as well as persons who engage in risky behavior. The risk of acquiring HIV is between two to five higher where a patient has a sexually transmitted disease especially of the ulcerative kind at the time of exposure. Patient management by syndrome is necessary towards addressing the increasing challenge posed by STDs. Gonorrhea and Chlamydia are top the list of organisms that cause Urethritis and Cervitis. Dual therapy is recommended for gonorrhea treatment using intramuscular ceftriaxone and either doxycycline or azithromycin.
Ilina et al. (2013) conducted a research to identify the molecular mechanism that is responsible for spectinomycin resistance in the gonococcus bacteria. The rationale for the research is that spectinomycin is a useful reserve option for treating gonorrhea. This is particularly significant since strains of Neisseria gonorrhoeae strains have emerged that exhibit decreased susceptibility to ceftriaxone and cefixime. Thus, spectinomycin is the only drug that is effective for treating analogous cases of gonorrhea infection. The adoption of spectinomycin as a drug of choice for routine use was followed by reports of resistance. From their study, the authors identified the primary molecular mechanism for spectinomycin resistance in Neisseria gonorrhoeae as C1192T substitution within 16S rRNA genes. The researchers found a Thr-24→Pro mutation in the ribosomal protein S5 (RPS5) that is found in the spectinomycin resistant N. gonorrhoeae strain. The high rate of transformation indicated the possibility that the spread of spectinonycin resistance is caused by the horizontal gene transfer (HGT). The study thus, provides additional clinical evidence for the existence of N. gonorrhoeae strains that have moderate spectinomycin resistance as a result of isolated mutations in the RPS5. These findings are important for surveillance and therapy in gonococcal infection. Suck knowledge is vital towards establishing effective antimicrobial therapy.
- Centers for Disease Control and prevention (CDC). (2013). Gonorrhea treatment guidelines:
Revised guidelines to preserve last effective treatment option. CDC Fact Sheet. Retrieved May 9, 2014 from http://www.cdc.gov/nchhstp/newsroom/docs/Gonorrhea-Treatment-Guidelines-FactSheet.pdf
- Elena N. Ilina, E., Malakhova, M., Bodoev, I., Oparina, N., Filimonova, A. & Govorun, V. (2013). Mutation in ribosomal protein S5 leads to spectinomycin resistance in Neisseria gonorrhoeae. Frontiers in Microbiology, Volume 4, Article 186, doi: 10.3389/fmicb.2013.00186
- Fanfair, R. & Workowski, K. (2014). Clinical update in sexually transmitted diseases –2014.
Cleveland Clinic Journal of Medicine, Volume 81, Number 2, doi:10.3949/ccjm.81a.13090.
- Ohneck, A., Zalucki, M., Johnson, J., Dhulipala, V., Golparian, D., Unemo, M., Jerse, E. &
Shafer WM. 2011. A novel mechanism of high-level, broad-spectrum antibiotic resistance caused by a single base pair change in Neisseria gonorrhoeae. MBio.M Sep 20; 2 (5).
- Whiley, D., Goire1, N., Lahra, N., Donovan, B., Limnios, A., Nissen, D. and Sloots, T. (2012). The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting. Journal of Antimicrobial Chemotherapy, 2012; 67: 2059–2061. doi:10.1093/jac/dks188