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Abstain from sex. All we hear from public health bodies is that “it’s the only way to completely avoid STIs.” Don’t have vaginal, anal, or oral sex. (Read this also | Sexually transmitted infections: Know how STIs and STDs cause infertility, and ways to prevent it,
It’s grim advice. But when you read the latest data from the European Centre for Disease Prevention and Control (ECDC) on the spread of gonorrhoea, a bacterial sexually transmitted infection (STI), and antimicrobial resistance (AMR), it sounds absolutely correct.
Antibiotics such as azithromycin, ceftriaxone and cefixime are common medical treatments for treating gonorrhea, but they are becoming increasingly ineffective. And this is likely contributing to the increase in gonorrhea cases and STIs in general in Europe, if not globally.
The ECDC said in a report published on June 10, 2024 that the total number of confirmed cases of gonorrhea in the 28 EU/EEA (European Union/European Economic Area) countries in 2022 rose to 70,881 – a 48% increase compared to the previous year.
AMR is one of the reasons why antibiotics are failing in public health efforts everywhere – whether it’s for STIs or earaches. Either we use them too much, or we don’t bother to take all the pills, resulting in bacteria being able to develop resistance to many of our “go-to” drugs of the past 100 years.
What is gonorrhea?
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. It can affect the genitals, rectum, and/or throat. The infection is common in young people aged 15-24 years.
Women often do not have symptoms, and when they do, the symptoms are mild and may be mistaken for another vaginal or bladder infection – women are at higher risk than men, as diagnosis is harder. And pregnant women are especially at risk, as they can pass an STI infection to an unborn baby. Women may also suffer prenatal complications or become infertile due to an undiagnosed STI.
Men, on the other hand, also have symptoms, including a burning sensation when urinating, white, yellow, or green discharge, and/or pain or swelling in the testicles.
“But it is much rarer than it appears in women. We should prioritise women because they don’t have any symptoms,” said Teodora Elvira Wai, who leads global HIV, hepatitis and STI programmes at the World Health Organization in Geneva.
“We need opportunities for women to get tested for STDs, especially those at high risk, those who have multiple partners and sexually active teens,” Wai said.
Antimicrobial resistance to common antibiotics for gonorrhoea ‘worrisome’
The ECDC report includes analysis of 4,396 gonorrhea samples (or “isolates”) collected in 2022 from 23 countries.
They found that “isolates resistant to azithromycin increased significantly to 25.6%, compared to 14.2% in 2021.”
Since azithromycin is often combined with ceftriaxone, the ECDC described these findings as “particularly worrying”.
Resistance to ciprofloxacin also increased, but not as significantly – 65.9% of isolates showed resistance in 2022, up from 62.8% in 2021.
Resistance to cefixime remained “low at 0.3%”.
Overall, the ECDC’s figures mirror those seen by the World Health Organization in other regions, including Africa and Asia.
“Antimicrobial resistance is not the only reason [there]”But in countries where antimicrobial resistance is even more prevalent than in Europe, it is contributing to the rise in bacterial STIs,” Wai said, adding that globally, 73 countries have reported data on antimicrobial resistance in gonorrhoea.
ECDC data indicated an increase in pharyngeal (throat) gonorrhoea, while genital and anorectal gonorrhoea cases remained stable in 2022.
How to slow the spread of sexually transmitted diseases (STIs)?
Global WHO data from 2020 showed that there are 374 million new cases of syphilis, gonorrhoea, chlamydia and trichomoniasis each year among people aged 15-49 years. WHO cited the following reasons for the rising number of STI cases:
Increase in unsafe sexual behavior, including decreased condom use, increased numbers of partners and casual partners
Asymptomatic infection and socio-economic impact; biological factors
Poor access to STI services, lack of equipment for diagnostic tests due to lack of STI services and inadequate funding of services
Stigma: STI patients do not seek care, and stigma results in less funding for STI services and research
Addressing and/or reversing these factors would be a good start in public health efforts to bring sexually transmitted diseases under control.
But don’t stop having sex altogether, Wai said — instead, get educated about sex. “Have sex, enjoy sex, make it voluntary, do it for your sexual health and protect yourself the same way you protect yourself from other infections,” he said.
Main Source:
Gonococcal antimicrobial susceptibility surveillance in the EU/EEA, European Centre for Disease Prevention and Control, June 2024
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