WHO updates treatment guidelines on syphilis, other STIs

rapid plasma reagin blood test card for syphilis
Copyright: Sven Torfinn / Panos

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  • The three STIs in WHO monitor are generally curable with antibiotics
  • When left undiagnosed, the infections become more difficult to treat
  • Western Pacific, South-East Asia account for 60 per cent of new cases

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[MANILA] Due to the growing threat of antibiotic resistance,the WHO has updated its treatment guidelines for gonorrhoea, syphilis and chlamydia, three common sexually transmitted infections (STIs).
The three STIs are generally curable with antibiotics but often go undiagnosed and are becoming more difficult to treat, with some antibiotics even failing.

“Overall, Asia contributes to the development of resistance due to the misuse and overuse of antibiotics.”

Teodora Wi, WHO


According to the new WHO 2015 report on global STI surveillance, there are roughly 207 million new cases of curable STIs in the Western Pacific and South-East Asia regions combined, which comprise almost 60 percent of new STI cases globally.
“Overall, Asia contributes to the development of resistance due to the misuse and overuse of antibiotics, including penicillin and quinolones, which then spreads globally through travel,” Teodora Wi, a medical officer at the WHO’s Department of Reproductive Health and Research in Geneva, Switzerland, tells SciDev.Net.
Of the three STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. To treat gonorrhoea, the WHO does not recommend the use of quinolones, a classic antibiotic, due to widespread high levels of resistance.
To cure syphilis, the new WHO guidelines strongly recommend a single dose of benzathine penicillin which is injected into the infected patient’s butt or thigh muscle. This is more effective and cheaper than antibiotics.
For genital infections and lymphogranuloma venereum, a disease caused by three unique strains of chlamydia, the WHO offers nine treatment recommendations.
David Lewis, a professor specialising in infectious diseases at the University of Sydney and director of the Western Sydney Sexual Health Centre, tells SciDev.Net that he is concerned because only a minority of gonorrhoea cases are diagnosed in resource-limited settings, including South-East Asia.

In these places, diagnosis depends on a patient presenting a symptom associated with gonorrhoea. This works well for heterosexual men, most of whom exhibit profuse urethral discharge, but the majority of gonorrhoea infections in women and men who have sex with men are asymptomatic and hence difficult to detect, says Lewis.
When left undiagnosed and untreated, gonorrhoea, syphilis and chlamydia can result in significant complications and long-term health issues for women, such as pelvic inflammatory disease, ectopic pregnancy and miscarriage. It can also increase a person’s risk of being infected with HIV two- to three-fold, according to the WHO. Untreated gonorrhoea and chlamydia can cause infertility in both men and women. When used correctly and consistently, condoms are one of the most effective methods of protection against STIs.
This piece was produced by SciDev.Net’s South-East Asia & Pacific desk.