As the rates of gonorrhea continue to rise in Canada, health officials are sounding the alarm about the infection becoming more resistant to antibiotics. This could potentially lead to untreatable cases of the sexually transmitted infection (STI). The World Health Organization (WHO) issued a media release on Monday, stating that several countries, including Canada, are experiencing a growing number of treatment failures for gonorrhea.
Gonorrhea, a common STI, is typically treated with drugs like ceftriaxone. However, a specific strain of the bacteria responsible for gonorrhea, Neisseria gonorrhoeae, has developed a significant level of resistance to ceftriaxone and other antibiotics, such as penicillin.
Dr. Ameeta Singh, an infectious disease specialist at the University of Alberta, stated that gonorrhea rates in Canada and globally have been steadily increasing for many years. She also mentioned that every antibiotic used to treat gonorrhea eventually becomes ineffective due to the bacterium’s development of resistance.
Antimicrobial resistance in gonorrhea remains a significant concern for public health in Canada, according to the Public Health Agency of Canada (PHAC). PHAC spokesperson mentioned that overall rates of gonococcal infection are on the rise, particularly among adolescents and young adults. Neisseria gonorrhoeae, the cause of gonorrhea, has displayed resistance or decreased susceptibility to many antibiotics, potentially leading to the emergence of untreatable cases of gonorrhea in Canada.
The symptoms of gonorrhea vary, and many infected individuals, especially females, may not experience any symptoms. Common symptoms in men include a burning sensation during urination, discharge from the penis, and pain or swelling in the testicles. In women, early symptoms are often mild and can be mistaken for a bladder or vaginal infection. Other symptoms include a burning sensation during urination, vaginal discharge, lower abdominal pain, pain during sex, and vaginal bleeding between periods or after sex. If left untreated, gonorrhea can have severe consequences and even lead to death in both women and men.
In women, the infection can spread to other reproductive organs, causing infertility. It can also affect other parts of the body, leading to issues like joint inflammation, liver inflammation, and brain damage. Infants born to untreated parents may experience eye problems that can result in blindness. In men, untreated gonorrhea can cause infertility and lead to inflammations in the testicles, liver, and brain.
Gonorrhea is the second most commonly reported STI in Canada, and rates have nearly tripled from 2010 to 2019. During this period, gonorrhea rates were consistently higher among males than females. More than half of reported cases in 2019 were among people under 30 years of age.
There are various theories as to why gonorrhea rates are increasing, including the introduction of more sensitive diagnostic tools that detect more cases. However, the rise of antibiotic-resistant gonorrhea is believed to be the primary reason. Since 2011, two antibiotics, ceftriaxone and azithromycin, have been primarily used to treat gonorrhea, aiming to reduce the development of resistance. While this strategy has worked in some parts of the world, such as Alberta, other regions like Manitoba and Saskatchewan have seen a higher level of resistance.
Neisseria gonorrhoeae is a multi-drug-resistant organism that has proven resistant to many treatment options. Like all living organisms, the bacterium can undergo genetic mutations. When antibiotics are used, they target and kill the bacteria, but some bacteria may have mutations that make them less susceptible to the antibiotic’s effects. This is the case with gonorrhea. While antibiotics may kill most of the bacteria causing the infection, some resistant bacteria can survive and multiply, passing on their resistance genes. Over time, these resistant strains become more prevalent in the population.
Dr. Singh stated that the resistant strains of gonorrhea are primarily arising in Asia. Cases of multi-drug-resistant gonorrhea in Canada have been acquired by individuals who either had sexual contact with individuals in Asia or those who have traveled from Asia to Canada. Once the resistant strain enters the population, it can continue to spread.
In 2022, the WHO established a Global Health Sector Strategy on HIV, Hepatitis, and STIs, setting targets to reduce the number of new gonorrhea cases. The goal is to reduce global rates of infection by 90% among people aged 15 to 49 by 2030. However, Dr. Singh believes this may be too ambitious given the challenges of combating drug-resistant strains and the need for comprehensive efforts in education and prevention. She emphasized the importance of accessible and accurate testing, as many gonorrhea infections are asymptomatic. Additionally, vaccine development may play a role in prevention, as some data suggests that vaccines used to prevent meningitis could also prevent cases of gonorrhea. Currently, there are no licensed vaccines available specifically for gonorrhea.
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