By Christopher Oseh, MBBS
Antibiotics resistance is gradually expanding, and the clinical efficacy of newer generations of antimicrobial drugs is declining. As a result, healthcare providers face a herculean task in treating gonococcal and chlamydia sexually transmitted infections (STDs).
The World Health Organization estimates that the global prevalence of gonococcal sexually transmitted infections has increased by 50 million within five years. A significant number of these cases were recorded in Africa. Healthcare workers need to stay updated with new treatment guidelines to fight against the upsurge of resistant gonococcal and chlamydia STDs.
What are the current treatment guidelines for managing chlamydia and gonococcal STDs?
In this article, you will learn how to manage resistant STDs, especially gonorrhea antibiotic resistance, and the mechanism behind the widespread occurrence of resistant gonococcal STDs.
Major bacteria cause of sexually transmitted diseases
A plethora of bacteria organisms causes sexually transmitted diseases, but Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum are the major causative bacteria organisms responsible for gonorrhea, chlamydia, and syphilis, respectively. In addition, gonococcal STDs are more resistant to antimicrobial treatment—even to first-line medications, unlike chlamydia and syphilis.
Why is antibiotic resistance prominent in sub-Saharan Africa?
In some sub-Saharan Africa countries, citizens have access to their local drug stores and can purchase antibiotics without a doctor’s prescription. This unrestricted access has increased the abuse and misuse of drugs, especially among young people who practice unprotected sexual intercourse. Oral drugs like penicillins are the worst hit because they are readily available. As a healthcare professional, it may be prudent not to include penicillins in your treatment regimen if you suspect its abuse from clients in your local area.
How does gonorrhea become resistant to antibiotics?
Neisseria gonorrhoeae antibiotic-resistant mechanism is linked to multiple genetic mutations at various levels. Here are the major mutations responsible for resistant gonococcal infections:
- B-lactamase gene mutation: This mutation is responsible for resistance to common antibiotics such as penicillin.
- Efflux pump mutation: This mutation causes antibiotics resistance to ciprofloxacin, azithromycin, and tetracyclines.
- Target site binding protein mutation: Results in mutation to drugs such as cephalosporins and penicillin.
Neisseria gonorrhoeae may have one or more of these mutations, and treatment becomes difficult with multiple genetic alterations.
Does chlamydia have antibiotic resistance?
Chlamydia trachomatis may develop antibiotics resistance to previously susceptible drugs, but this is not as common as in gonococcal infections. Treatment failure has been found in some individuals who were given a short course azithromycin and doxycycline combination. A research study conducted in the United Kingdom on Azithromycin-resistant genital Chlamydia found that longer treatment duration played a critical role in reducing the incidence of treatment failure in patients who had genital chlamydia infections. The researchers recommended a minimum treatment duration of 7 days for improved outcomes.
How is antibiotic-resistant chlamydia treated?
In its updated guidelines, the Centers for Disease Control and Prevention (CDC) recommends the following treatment regimen for chlamydia genital infection among adolescents and adults:
- Caps Doxycycline 100mg twice daily for seven days. This is typically the first-line treatment option.
- Tabs Levofloxacin 500mg once daily for seven days. This is an alternative treatment to doxycycline. Levofloxacin may be considered as a second-line treatment option.
In females, oral metronidazole can be added to either of the drugs above to prevent pelvic inflammatory disease.
A meta-analysis that compared the therapeutic efficacy of doxycycline and azithromycin in patients with genital chlamydia showed that the cure rate was higher with doxycycline than with azithromycin.
Also, a few weeks after completion of treatment, the guideline stipulates that healthcare professionals should conduct a test of cure to confirm clearance of chlamydia organisms in the genital tracts. This post-therapy test helps to differentiate treatment failure from reinfection cases.
For men, the test of cure is a urethral swab. For women, an endocervical swab is appropriate. These swab samples are taken to the laboratory for microscopy and culture tests to determine if any chlamydia organisms will be isolated after two days of culture.
To reduce the rate of reinfection, it is also recommended to conduct swab tests on sexual partners and treat confirmed or asymptomatic patients using the doxycycline treatment regimen.
How to treat gonorrhea antibiotic-resistance
Gonorrhea and genital chlamydia infections often coexist, so it is prudent to exclude the other when considering the antibiotics to administer.
The antibiotic-resistant pattern for Neisseria gonorrhoeae differs from country to country, so adapt this regimen to your country’s guideline based on clinical reports on the local antimicrobial sensitivity pattern.
The following are the updated CDC treatment guidelines for uncomplicated urogenital gonococcal infection:
- IM ceftriaxone 500mg stat for people less than 150 kg and 1g stat for those greater than 150 kg. This is typically the first-line treatment option.
- IM Gentamicin 240mg stat + 2g Azithromycin stat. This is an alternative treatment to ceftriaxone and may be considered as a second-line treatment option.
A test of cure is also essential to confirm clearance of the Neisseria organisms and to identify cases of drug resistance.
A study that compared the therapeutic efficacy of IM ceftriaxone and IM gentamicin found that participants treated with IM ceftriaxone had a 98% clearance rate compared to 91% clearance rate in the group treated with gentamicin.
These figures further support the therapeutic efficacy of IM ceftriaxone.
However, in some cases of suspected ceftriaxone resistance, a urethra swab for laboratory microscopy, culture, and sensitivity test should be carried out to identify the antibiotics sensitivity pattern of the organism.
Clinically evaluate and carry out laboratory tests for sexual partners of infected patients to exclude asymptomatic genital gonococcal infections.
This is critical because some research studies have found that reported resistance cases were in fact reinfection from asymptomatic sexual partners.
Final Thoughts
Healthcare professionals in some sub-Saharan African countries may have no or limited access to quality research studies and data to support the prescription and use of the right combination of antibiotics for sexually transmitted infections.
Healthcare workers are sometimes left to their clinical acumen to select the appropriate drugs, especially for gonorrhea antibiotic resistance.
Therefore, using these highlighted treatment guidelines and staying updated with current trends will empower sub-Saharan healthcare workers with insight into how best to treat antibiotic-resistant infections.
Dr. Christopher Oseh is an experienced primary care physician, health blogger, content marketing professional, and self-published author. He specializes in creating content for health care providers and health technology companies.
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