Gonorrhea cure gets tough as bug grows drug resistant

At a time when the controversy over the antibiotic resistant superbug in the capital’s hospitals refuses to die down, Indian researchers have found that the prevalence of multi-drug resistant (MDR) gonorrhea has been increasing over the last decade – posing a potential risk to fighting one of the most common sexually transmitted infection (STI) with antibiotics.

According to studies conducted by the Safdarjung Hospital’s centre on STIs, a significant increase has been seen in the resistance of the disease-causing bacteria against penicillin and ciprofloxacin – the most trusted antibiotics for treating gonnorhea.

Increased and unwanted use of antibiotic drugs was a major reason for the increased resistance, said experts.

“Over the last decade, neisseria gonnorhea (the bacteria) strains have developed a very high resistance against treatment-related antibiotics such as penicillin and tetracycline across the world, including India. This basically means that the disease cannot be treated by such drugs that were once single-dose treatment for gonorrhea in India,” Manju Bala, author of the study and consultant at the Regional STD Teaching, Training and Research Centre at Safdarjung Hospital, told IANS.

“We have found that between 2001 and 2009, of the total gonorrhea cases screened at our centre, 26 percent had MDR gonorrhea,” she said.

According to another study conducted by the centre at Safdarjung Hospital, nearly 47.4 percent gonorrhea samples were resistant to penicillin.

The study, published in the Journal of Antimicrobial Chemotherapy in 2007, stated that a total of 386 specimens from male and female patients tested positive for the bacteria. Strains with powerful multiple resistance to antibiotics were observed in 89 cases – implying that the disease could be untreatable in the times to come.

The disease spreads through contact with penis, vagina, mouth or anus and can also be transmitted from mother to baby during delivery. Nearly 200 million cases are reported annually from across the globe.

Gonorrhea grows and multiplies easily in the warm, moist areas of the reproductive tract. The infection can also grow in the mouth, throat, eyes and anus. People with gonorrhea can more easily contract the HIV virus.

“MDR gonorrhea has been reported from many other nations across the world, including Japan and the US. But India’s high HIV prevalence puts us in danger as MDR gonorrhea bacteria will also be powerful in transmitting HIV infection,” said Somesh Gupta, assistant professor at the department of dermatology and venereology at the All India Institute of Medical Sciences.

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“Multi-drug resistance among gonorrhea strains has already been reported across the globe as the bacteria becomes resistant to antibiotics through evolution. The group of surviving bacteria reproduce and pass the resistance-mechanism to offspring,” he said.

The study published in the Journal of Antimicrobial Chemotherapy said among 301 specimens, nearly 164 showed reduced susceptibility to penicillin, bringing them close to the stage of ineffectiveness to the drugs. Penicillin resistance increased significantly from 0.8 percent in 2002 to 68.4 percent in 2003.

Officials from the health ministry said so far there has been no cause for worry for India that has already spent a decade in fighting MDR tuberculosis (TB), not to miss the hospital ‘Superbug’.

“If the prevalence of drug-resistant bacteria strains increases, then, yes, it could be problematic for India. We have already fought a long battle against MDR TB with the help of DOTS treatment. At the same time, we cannot be lenient with the unchecked distribution and use of antibiotics in India,” an official from the National AIDS Control Organisation (NACO), under the health ministry, told IANS on condition of anonymity.

“When we continue living with the prevalence of a resistant and powerful disease-causing organism over a period of time, it becomes difficult to treat the disease with simple and programmed drugs. MDR gonorrhea needs to be taken seriously,” Bala said.

The World Health Organisation constituted a programme in the Southeast Asian region where countries pool data on MDR gonorrhea.

“NACO has engaged around 4,000 private STI clinics which will be given colour-coded kits through which even a non-MBBS worker could provide treatment to the STI-infected person. We are minimising the use of random antibiotics,” said T.L.N. Prasad, technical expert with the national technical support unit of NACO.

Suraksha Clinics, as these would be known, were chosen keeping in view “the comfort level of the high-risk groups such as sex workers and transgenders to visit a clinic for the STIs”, he said.

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