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Problem of resistance: STIs are becoming more difficult to control

Neisseria gonorrhea has developed resistance to a number of antibiotics used to treat it, according to an Oct. 9 press release issued by the European Academy of Dermatology and Venereology.

N. gonorrhea can acquire resistance in several ways: by acquiring plasmids, by transformability (ability to acquire DNA from the environment and incorporate it in the genome) and by standard mutational resistance, the author wrote.

Efforts to stem the spread of cephalosporin resistance are currently focused on the following:

  • Dual therapy using azithromycin or doxycycline along with ceftriaxone. The 2015 U.S. Centers for Disease Control and Prevention guidelines recommend dual therapy using the injectable generic antibiotic ceftriaxone and oral azithromycin as first-line treatment.

  • Efforts to prevent N. gonorrhea infection through education and condom use. These strategies may delay but will not halt the worldwide emergence of totally resistant N. gonorrhea. The Gonorrhoea Antimicrobial Surveillance Programme (GASP) organized by the World Health Organization is already in place in some countries, but needs to be implemented worldwide.

  • A more tentative use of antibiotics in general: asymptomatic carriage of N. gonorrhea in the rectum and throat is common in patients who are often treated with single antibiotics for other infections. As there is usually no inflammation from a throat or rectal infection, antibiotic concentrations are low enough in these areas to allow development of resistance either in N. gonorrhea itself or in other commensal bacteria.

The authors added that in addition to these efforts, a number of new agents targeting N. gonorrhea are being investigated in clinical trials.

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