STI Synopsis
Gonorrhea
Antimicrobial resistance threatens to make gonorrhea untreatable, with significant sexual and reproductive health consequences
Gonorrhea is caused by the bacteria, Neisseria gonorrhoeae. Infections can be cured with antibiotics, but over the decades it has acquired resistance to nearly every medicine used to treat it. Additionally, gonorrhea infections are typically asymptomatic, especially among women, highlighting the importance of early detection to limit the spread of the infection.
Vaccines
Researchers believe that a gonorrhea vaccine is possible, particularly because epidemiological evidence shows that some vaccines against meningitis B, which is caused by a pathogen closely related to the bacteria causing gonorrhea, may reduce new gonorrhea infections. Clinical trials are underway to study the effectiveness of meningitis B vaccines against gonorrhea. Several other, different types of gonorrhea vaccine candidates are in preclinical development.
Next steps identified in the Roadmap include:
Assess Public Health Value
- Obtain better data on the burden of gonorrhea-associated infertility, and other adverse consequences, in different settings globally
- Monitor antimicrobial resistance of gonorrhea. The WHO Global Gonococcal Antimicrobial Surveillance Program (GASP), which has been documenting the emergence and spread of AMR in gonorrhea globally since 1992, shows high and increasing resistance to ciprofloxacin and azithromycin along with decreased susceptibility or resistance to ceftriaxone and cefixime.
- Continue to model the theoretical impact of gonorrhea vaccines
Facilitate Research and Development
- Continue to advance basic science, translational research and clinical development of gonorrhea vaccines
Optimize Global Benefits and Access
- Leverage existing WHO preferred product characteristics (PPCs) to encourage innovation and development of gonorrhea vaccines for use where they can have the greatest impact
- Lay the groundwork for fast, targeted rollout of vaccines so they are accessible to those who would benefit the most
Testing
Gonorrhea testing includes both culture and nonculture methods. Historically, culture tests were considered the gold standard to detect gonorrhea, but NAAT tests, a nonculture method, are now considered the gold standard after demonstrating high sensitivity and specificity. Additionally, NAATs can often conduct tens to hundreds of tests at a time.
Many newer diagnostics have combined chlamydia and gonorrhea tests to detect both at once. Point-of-care (POC) and near-POC tests that can be used in community and clinical settings are becoming more available. These tests can help to limit the time between test and treatment, limiting the spread of infections.
82.4 million new cases each year.
Can cause serious health problems, particularly for women, including pelvic inflammatory disease (PID), infertility, pregnancy complications, and elevated risk for HIV acquisition and transmission.
Gonorrhea can be cured with antibiotics, but over the decades it has acquired resistance to nearly every medicine used to treat it. Gonorrhea may be asymptomatic, especially in women, and there is limited availability of affordable, accurate and timely diagnostic tests.
Source: STI Fact Sheet
WHO background on gonorrhea vaccines
WHO preferred product characteristics for gonococcal vaccines. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
CIDRAP/Antimicrobial Resistance Fighter Coalition. Podcast Episode 8: The Clap Claps Back – Resistant Gonorrhea. Superbugs and You. Nov 2021.
Lin EY, Adamson PC, Klausner JD. Epidemiology, Treatments, and Vaccine Development for Antimicrobial-Resistant Neisseria gonorrhoeae: Current Strategies and Future Directions. Drugs. 2021 Jul;81(10):1153-1169. doi: 10.1007/s40265-021-01530-0. Epub 2021 Jun 7.
Gottlieb SL, et al. Gonococcal vaccines: Public health value and preferred product characteristics; report of a WHO global stakeholder consultation, January 2019, Vaccine, Volume 38, Issue 28, 2020, Pages 4362-4373, ISSN 0264-410X.
Whittles LK, White PJ, Didelot X. Assessment of the Potential of Vaccination to Combat Antibiotic Resistance in Gonorrhea: A Modeling Analysis to Determine Preferred Product Characteristics. Clin Infect Dis. 2020 Nov 5;71(8):1912-1919. doi: 10.1093/cid/ciz1241. PMID: 31905399; PMCID: PMC7643747.
Gottlieb SL, Jerse AE, Delany-Moretlwe S, Deal C, Giersing BK. Advancing vaccine development for gonorrhoea and the Global STI Vaccine Roadmap. Sex Health. 2019 Sep;16(5):426-432. doi: 10.1071/SH19060.
Craig AP, Gray RT, Edwards JL, Apicella MA, Jennings MP, Wilson DP, Seib KL. The potential impact of vaccination on the prevalence of gonorrhea. Vaccine. 2015 Aug 26;33(36):4520-4525. doi: 10.1016/j.vaccine.2015.07.015.