Clinics in Thailand target antibiotic-resistant gonorrhoea

November 2015

Nobody wants to face the worry and stigma of being sick with gonorrhoea or another sexually transmitted infection. But until recently, being diagnosed with gonorrhoea may not have seemed so frightening because the illness could be cured by taking a single antibiotic injection or pill.

Silom Community Clinic/N. Tippanont

This may soon change. Gonorrhoea is on a growing list of infections that may soon become untreatable. Gonococci – the bacteria which cause the infection – are becoming increasingly resistant to the antibiotics that formerly killed them. Multidrug-resistant gonorrhoea has been reported in 36 countries.

“Ten countries have already reported cases of gonorrhoea that do not respond to the current treatment recommendations. Gonorrhoea may soon become untreatable because no vaccines or new drugs are in development,” says Dr Marleen Temmerman, Director of the Department of Reproductive Health and Research at WHO.

“Gonorrhoea may soon become untreatable because no vaccines or new drugs are in development.”

Dr Marleen Temmerman, Director, Department of Reproductive Health and Research, WHO

Untreated gonorrhoea can result in serious illness and complications, such as infertility in women, pregnancy complications, and blindness for babies who get infected during birth.

Efforts in Thailand

To prevent the spread of gonorrhoea, including the drug-resistant type, it is vital that people get diagnosed and receive appropriate care promptly. Yet people can be reluctant to seek medical help for symptoms of a sexually transmitted infection (STI) like gonorrhoea if they feel embarrassed or ashamed. This may be especially true for people who already feel marginalized, such as men who have sex with men and transgender people. They are even less likely to attend a follow up clinic, so it is vital that they are offered effective treatment when they do attend.

Thailand is a pathfinder for providing non-discriminatory health services and addressing gonorrhoea. Because they are working hard at reaching people who have gonorrhoea, they are also in an ideal position to improve surveillance – tracking how many people have the illness, obtaining some demographic information and accurately assessing what treatment they need.

Critical role of surveillance

WHO has been deeply concerned about antibiotic-resistant gonorrhoea for more than 2 decades. In 1992, the Organization launched the Gonococcal Antimicrobial Surveillance Programme (GASP) to track the emergence and spread of resistance to treatments in gonorrhoea, and re-launched it in 2008.

In November 2015, Thailand’s Ministry of Public Health is launching an enhanced local version of GASP with support from the United States Centers for Disease Control and Prevention (CDC) and WHO.

“We are eager to begin this activity that will provide key information on antibiotic-resistant gonorrhoea. It will help us make sure we have the right treatment guidelines in place and to provide early information about gonorrhoea that may be difficult to treat,” says Dr Pachara Sirivongrangson, Senior Advisor on HIV and other STIs with the Department of Disease Control, Thai Ministry of Public Health.

The programme will boost the country’s existing surveillance system by standardizing procedures for testing samples of gonorrhoea in laboratories and capture additional clinical and demographic data.

“The project is being initiated at 2 sites in Bangkok: the Silom Community Clinic @ Tropical Medicine and the Bangrak Hospital STI clinic. Patients who come into the clinics who have symptoms will have a sample collected for gonorrhoea, and they will provide demographic and some behavioural information. The samples will be evaluated for gonorrhoea and possible drug resistance,” explains Dr Eileen Dunne, a medical officer and epidemiologist at Thailand Ministry of Public Health-U.S. CDC Collaboration.

The data collected at the initial sites, and others when the project is scaled up, are sent to the Thai Ministry of Public Health and will be used to adjust national treatment and management guidelines. If the data shows that there is a lot of resistance to an antibiotic that is currently recommended for the treatment of gonorrhoea the treatment guidelines will be adjusted. The data will also help WHO to monitor global trends and compare the situation in different countries.

Seeking improved approaches worldwide

Enhanced surveillance of gonorrhoea is critical because it lays the groundwork for accurate and cost effective approaches to treating the disease. Today, many patients diagnosed with gonorrhoea are given last option antibiotics that should ideally be kept in reserve, just in case their infection is caused by an antibiotic-resistant strain that won’t be cured by older medicines.

Countries with surveillance systems for antibiotic-resistant gonorrhoea, such as the United States of America, United Kingdom and Australia, have successfully monitored trends in resistance and have consequently changed treatment guidelines at the right time. This ability, to assess and recommend the most effective antibiotic regimen available, has been critical for gonorrhoea control in these countries.

WHO is helping other countries to strengthen their surveillance for antibiotic-resistant gonorrhoea, so that they can use their own data to formulate evidence-based local treatment guidelines. The enhanced surveillance programme will provide additional demographic and clinical data that have not been available in existing programmes to track resistance early and prevent it from spreading. Thailand will be the first country in the region to conduct enhanced GASP, and the project is meant to serve as a model for others.