Gonorrhoea: Drug Resistance in Australia

Drug-resistant gonorrhoea is a looming problem for Australian sexual health. However, with vigilance and preparation, we can prevent this potential crisis coming to fruition.

Cases of gonorrhoea that are resistant to the drug azithromycin have increased. And a further two cases of gonorrhoea diagnosed in Australia in 2018 were multi-drug resistant, overcoming first line treatment against gonorrhoea. It is likely there are more undetected cases of multi-drug resistant gonorrhoea in Australia.

While these instances are a concern, media coverage has implied this is a bigger current problem than it actually is. Some reporting suggests gonorrhoea has extremely high levels of resistance to all treatments and that the bacteria is virtually untreatable. This is not the case. The combination of ceftriaxone and azithromycin continues to be effective in the vast majority of cases with extremely low resistance to ceftriaxone in the Australian community. Moreover, older antibiotics can also be used to treat individuals who acquire a strain of gonorrhoea that is resistant to ceftriaxone and azithromycin. As such, drug resistant gonorrhoea is not a significant problem in the Australian community at this time.

It would, however, be a significant public health issue if multi-drug resistant gonorrhoea were to become established in Australia. This is because multi-drug resistant gonorrhoea is significantly more complicated to treat, as there are few antibiotic options left to treat it that are simple, well-studied, highly tolerated and effective. Given this, there is concern that some strains of gonorrhoea may become difficult if not impossible to cure.

For these reasons, it’s essential that effective strategies are put in place now to prevent problems in the future. These strategies include research and development of new antibiotics and clinical measures to better safeguard our existing antibiotics.

It is also important to reduce the rate of gonorrhoea, both for its immediate health impact on individuals and to reduce the risk of treatment-resistant strains emerging. To achieve this, we need to address the incidence of gonorrhoea in the Australian community through increased screening to reduce the time between infection and diagnosis.

Population-wide health promotion is critical as it increases awareness of how gonorrhoea is transmitted and promotes frequent STI testing and condom use. In many cases, gonorrhoea can be asymptomatic – especially where the infection is present in the throat – meaning an individual can have few or no symptoms. Detection of pharyngeal (throat) gonorrhoea, therefore, cannot rely on a person recognising their symptoms alone. Early detection through frequent testing and immediate treatment is essential to limit further transmission and the emergence of antimicrobial resistance.

We also need to improve access to testing and treatment services, varying our strategy for each key population. For example, frequency of testing among gay and bisexual men could be more improved with greater investment in peer-led STI screening clinics. Among Aboriginal and Torres Strait Islander communities, the response must improve access to primary healthcare, and better symptom recognition for men with urethral discharge. For heterosexual women and men, it should be easier for General Practitioners to offer STI screening and for individuals in a medical consultation to ask for an STI test.