The World Health Organization (WHO) on Tuesday issued new treatment guidelines for three sexually transmitted infections (STIs) (chlamydia, gonorrhea and syphilis), saying the updates respond to an "urgent need" in light of increasing antimicrobial resistance.
"Chlamydia, gonorrhoea and syphilis are major public health problems worldwide, affecting millions of peoples' quality of life, causing serious illness and sometimes death. 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," said Ian Askew, director of reproductive health and research at WHO.
According to WHO, the three bacteria cause more than 200 million infections each year, and growing resistance has made them more difficult or impossible to treat with modern antibiotics. Of the three infections, WHO says, gonorrhea is the most difficult to treat, with some strains now resistant to all available antibiotics.
When drafting the guidelines, WHO says it looked for treatments that offered high efficacy and quality while keeping in mind cost, toxicity, route of administration, as well as the likelihood for resistance to the treatments developing.
In addition to revamping its treatment recommendations, WHO says that individual health systems must step up surveillance for the infections, and urges countries to quickly adopt the new guidelines.
For gonorrhea, WHO says that surveillance is especially important, and calls on countries to use data on local patterns of resistance to steer selection of the most effective treatment. The agency also says it no longer recommends treating gonorrhea with quinolones "due to widespread high levels of resistance."
For syphilis, WHO says it now recommends using a single injection of benzathine penicillin, which "is more effective and cheaper than oral antibiotics." However, despite being added to WHO's essential medicines list last May, the agency warns that the shortages of the drug have been reported in three regions due to "problems with manufacturing … lack of consistent demand, and a decrease in indications for use and its relatively low price."
For chlamydia, the most common of the three infections, WHO is conditionally recommending a number of antibiotic regimens, leaning heavily on dual therapies involving azithromycin and a second antibiotic, such as erythromycin or doxycycline as first-line therapies for most patients, with specific recommendations for pregnant women and infants.