Antibiotics are prescribed as therapeutic remedies for sexually transmitted diseases such as chlamydia and gonorrhea, which have bacterial origins. Recently, the WHO has decided to alter the current treatment strategies for three sexually transmitted diseases: chlamydia, gonorrhea and syphilis, due to growing worries about the increase in antibiotic resistance.

Increasing antibiotic resistance has rendered treatment of STDs with antibiotics futile. Prolonged exposure to antibiotics facilitates survival of the “fittest” (intrinsically resistant) bacteria, whilst the non-resistant bacteria die out. Over time, the bacterial population evolves into a pool of microorganisms that are mainly resistant to the antibiotic. Another important cause of antibiotic resistance is also spontaneous mutation, whereby bacteria change their genetic material.

STDs on the rise in Asia and globally


The United Nations health agency estimates that every year, 131 million people are infected with chlamydia, 78 million are infected with gonorrhea, and 5.6 million with syphilis. In 2005, the WHO estimated that in Southeast Asia alone, there were approximately 7.39 million cases of Chlamydia trachomatis, 8.37 million cases of gonorrhea, and 11.77 million cases of syphilis.

These vast numbers emphasise the need for effective treatment that can help contribute to control rates of transmission. According to an outpatient clinic in Singapore that specialises in providing services related to sexually transmitted infections, chlamydia, gonorrhea and syphilis comprise the three most commonly occurring STDs in the local population.

All three STDs are "major public health problems"


The focus on treatment of sexually transmitted diseases primarily stems from the fact that these conditions can severely impact quality of life for those affected. For example, both gonorrhea and chlamydia can result in pelvic inflammatory disease in females during later stages if left untreated. Gonorrhea is also associated with an increased risk of ectopic pregnancy and infertility. Syphilis can predispose affected individuals to heart and brain-related conditions that can result in paralysis and death.

Ian Askew, director of reproductive health and research at WHO states that, “Chlamydia, gonorrhea, and syphilis are major public health problems worldwide, affecting millions of peoples’ quality of life, causing serious illness and sometimes death.”

This requires immediate attention as changing treatment plans for these diseases may have positive impacts on mortality, economic productivity and levels of health on a global scale.

Additionally, WHO’s statements regarding the revised treatment strategies emphasies that gonorrhea has the “strongest resistance to antibiotics.” Currently, several strains of Neisseria gonorrhea, a gram-negative bacterium, exist that have developed resistance to the antibiotics that are currently being used.

New experimental treatments needed for STDs


The updated treatment guidelines for all three infections are based upon experimental evidence that was garnered through testing which treatments are most effective in curing these conditions. For treatment of gonorrhea, the guidelines discourage the use of quinolones, broad-spectrum antibiotics that were previously prescribed. Instead, the WHO urges healthcare professionals to evaluate which pharmaceutical products would be most effective in context of their local settings.

For syphilis, the suggested treatment is a “single dose of benzathine penicillin”, which is an injectable antibiotic. This is considered to be more efficacious and affordable in comparison to the current oral antibiotics that are being prescribed.

An issue of shortage of benzathine penicillin in syphilis-stricken countries is currently being addressed by the WHO by monitoring needs of countries on a regular basis. High rates of morbidity associated with infants and pregnant women have prompted immediate collaboration with stakeholders in the affected countries.

Tetracyclines such as doxycycline which were initially used to treat chlamydia have not demonstrated sufficiently strong effects to justify their continued use. Presently, treatments targeted towards cure of genital infections and other co-morbidities are encouraged.

Askew adds that, “The new WHO guidelines reinforce the need to treat these STIs with the right antibiotic, at the right dose, and the right time to reduce their spread and improve sexual and reproductive health.”

Whilst the revised treatment strategies will certainly help reduce prevalence of these infections, it is the responsibility of local authorities to ensure that these guidelines are implemented and followed. MIMS

Sources:
https://www.dsc-clinic.sg/Patient-Care/Prevention%20and%20Education/STI/Pages/STI-Statistics.aspx
http://www.medicalnewstoday.com/articles/312660.php
https://medlineplus.gov/gonorrhea.html
http://www.who.int/mediacentre/news/releases/2016/antibiotics-sexual-infections/en/
http://sti.bmj.com/content/87/Suppl_2/ii14.extract
http://www.cdc.gov/std/gonorrhea/lab/ngon.htm
http://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm
http://www.acog.org/Patients/FAQs/Gonorrhea-Chlamydia-and-Syphilis
http://www.who.int/reproductivehealth/topics/rtis/benzathine-penicillin/en/
https://www.drugs.com/doxycycline.html

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