Drug-resistant Sexually Transmitted Infections (STIs) undergo novel treatment approach in Australia

In a public health alert issued on the 5th of June, doctors and nurses in Australia's Northern Territory (NT) were directed to take a travel history as part of any assessment of patients presenting for a sexually transmitted infection (STI) screen. This move comes amidst growing concerns about extensively drug-resistant (XDR) gonorrhoea, a strain of the common STI caused by the bacteria Neisseria gonorrhoeae, which shows resistance to Ceftriaxone and Azithromycin, antibiotics routinely used to treat gonococcal infections.

According to the alert, the STI detected in the NT is XDR gonorrhoea. This development is significant, as it marks the first time such a degree of Ceftriaxone resistance has been seen in the region. The alert urges everyone, particularly those who are sexually active and have travelled to Southeast Asia, to get their STI screens done.

The rise of XDR gonorrhoea is a global concern, with the World Health Organisation estimating 374 million new infections with one of four STIs, including gonorrhoea, in 2020. In Australia, more than two-thirds of gonorrhoea notifications in 2023 were from males, with the overall infection rate having risen by 127% since 2014. Among Aboriginal and Torres Strait Islander peoples, the rate of gonorrhoea was more than four times the non-Indigenous figure.

In remote settings, testing for drug-resistant STIs can be a challenge due to limited access to laboratory testing and infrastructure. However, Molecular Point of Contact Testing (POCT) shows promise for diagnosing infectious diseases in such locations. According to UNSW research, POCT can accurately test for chlamydia and gonorrhoea just as well as a laboratory. POCT can enable patients to be diagnosed and treated on the same day, avoiding the need for health services to track down patients who are mobile and difficult to locate.

Current strategies for diagnosing and treating XDR gonorrhoea, especially in remote Aboriginal communities in Australia, focus on regional antimicrobial susceptibility, cautious use of existing antibiotics, and the development of novel treatments. Culture and antimicrobial susceptibility testing remain essential to confirm Neisseria gonorrhoeae infection and detect resistance patterns, allowing tailored treatment.

Due to increasing resistance, particularly low-level azithromycin resistance observed in Australian isolates, guidelines recommend increasing azithromycin dose from 1 g to 2 g in combination therapies for pharyngeal gonorrhoea to improve cure rates and delay further resistance development. Doxycycline Post-Exposure Prophylaxis (DoxyPEP) is effective for chlamydia and syphilis but shows variable efficacy against gonorrhoea, with higher resistance levels limiting its utility in some regions, including Australia.

New drugs such as zoliflodacin are in late-stage clinical trials and may offer alternative treatment if current therapies fail. TAXIS Pharmaceuticals is developing novel dihydrofolate reductase inhibitors (DHFRIs) targeting multi-drug resistant gonorrhoea strains, showing promise to overcome traditional resistance mechanisms. While no gonorrhoea-specific vaccine exists yet, research suggests that some antimeningococcal B vaccines might provide partial protection. Vaccine development is critical given rising antibiotic resistance but remains in early stages.

In remote Aboriginal communities, challenges like limited healthcare access make early diagnosis and tailored treatment harder. There is a critical need for culturally appropriate healthcare delivery, increased surveillance of resistance patterns, and deployment of effective treatment regimens that consider local resistance profiles.

In summary, current diagnosis relies on susceptibility testing to guide therapy; treatment emphasizes combination antibiotic regimens with adjusted dosages to counter resistance; and new drugs and vaccines are under development, which are crucial for managing extensively drug-resistant gonorrhoea, including in remote Australian Aboriginal populations.

The rise of XDR gonorrhoea is a global concern, requiring awareness in science, healthcare, and the workplace-wellness industry.
The World Health Organisation estimates 374 million new STIs globally, including gonorrhoea, in 2020, highlighting the need for medical-conditions research and awareness.
In Australia, gonococcal infections have seen a significant rise, particularly among males, with the overall infection rate having increased by 127% since 2014.
Among Aboriginal and Torres Strait Islander peoples, the rate of gonorrhoea was more than four times the non-Indigenous figure, emphasizing the need for diversity-and-inclusion in healthcare.
Limited access to laboratory testing and infrastructure in remote settings presents a challenge in diagnosing and treating drug-resistant STIs, increasing the importance of Molecular Point of Contact Testing (POCT).
POCT can accurately test for chlamydia and gonorrhoea in remote locations, enabling patients to be diagnosed and treated on the same day.
Regional antimicrobial susceptibility testing remains essential to confirm Neisseria gonorrhoeae infection and detect resistance patterns, allowing tailored treatment.
Guidelines recommend increasing azithromycin dose from 1 g to 2 g in combination therapies for pharyngeal gonorrhoea to improve cure rates.
Doxycycline Post-Exposure Prophylaxis (DoxyPEP) is effective for chlamydia and syphilis but shows variable efficacy against gonorrhoea.
New drugs such as zoliflodacin are in late-stage clinical trials, offering potential alternative treatments if current therapies fail.
TAXIS Pharmaceuticals is developing novel dihydrofolate reductase inhibitors (DHFRIs) to target multi-drug-resistant gonorrhoea strains.
No gonorrhoea-specific vaccine exists yet, but research suggests that some antimeningococcal B vaccines might provide partial protection.
Vaccine development is critical given rising antibiotic-resistance, although it remains in the early stages.
In remote Aboriginal communities, increased surveillance of resistance patterns and deployment of effective treatment regimens that consider local resistance profiles are critical.
Culturally appropriate healthcare delivery is essential for addressing challenges like limited healthcare access in remote communities.
The rise of chronic diseases, including XDR gonorrhoea, emphasizes the need for investment in environmental-science research to combat climate-change and its impact on public health.
Climate-change can affect food, water, and air quality, contributing to the spread of infectious diseases like gonorrhoea.
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Drug-resistant Sexually Transmitted Infections (STIs) undergo novel treatment approach in Australia