The Rise of Antimicrobial Resistant Gonorrhea

Centre for Cellular and Molecular Platforms C-CAMP

5 min readFeb 20, 2023

For a large part of human history, infections and their consequences were just a part of life. Early remedies to fight infections were in the form of botanicals, other natural substances like honey, and bloodletting. This changed with the discovery of the first antimicrobials, and more importantly, the first antibiotic in 1928- penicillin. In the last century we have been able to save millions of lives from infections but, in recent years, we have learnt that we cannot become complacent. To continue fighting infections, new innovations are necessary.

This is especially true of diseases like Gonorrhea, which have now started to become a challenge to treat.

What is Gonorrhea?

It is a sexually transmitted disease (STD) that is caused by the bacteria Neisseria gonorrheae. It can also spread to the babies of infected mothers. Since the bacteria colonise the urinary/genital tract, infected people may show symptoms such as painful urination, discharge or bleeding of genital areas. However, individuals may also be completely asymptomatic. If left untreated, gonorrhoea can lead to infertility, increased HIV and spread to other parts of the body, such as joints.

Prevalence

Despite technical advances, it remains a significant public health concern.

According to WHO estimates, there were 82.4M cases of gonorrhea in people aged 15–49 years in the year 2020 alone. In developing countries, the lack of routine screening for STDs prevents us from getting exact numbers for gonorrhoea prevalence in the population.

Among STD clinic patients in India, the prevalence varies from 3% to 19%. Gonorrhea infections are usually treated by single-dose antimicrobials, often with a single drug. However, the treatment of Gonorrhea is getting more complex due to the rise of antimicrobial-resistant (AMR) gonorrhea.

Role of AMR in Gonorrhea treatment

Antimicrobial resistance is a phenomenon in which microbial infections show reduced or no response to antimicrobials. AMR has been identified by the WHO as one of the top ten global healthcare issues of our time. By 2050, deaths due to AMR are projected to reach 10M every year, 2M in India alone; it is also described as a silent pandemic. AMR develops in response to unrestricted use, misuse or inappropriate selection of antimicrobials for the treatment of infections. Or, excessive use in other applications such as increasing the productivity of livestock, aquaculture and others. AMR can also develop due to mutations in the microbe’s genetic material, or through the transfer of genetic material between microbial populations.

As a consequence of AMR, infections like gonorrhea are prolonged in more people, increasing the spread as well as creating long-term complications. To diagnose gonorrhea, a urine or swab sampling is performed and then subjected to a Nucleic Acid Amplification Test (NAAT) to identify genetic material from N. gonorrheae. The samples may also be cultured in laboratory conditions to check for the growth of this bacteria. Often, these diagnostic tests may be time consuming and treatment with antimicrobials is started as a response to the symptoms in the patient.

In 1937, sulphanilamide was introduced as an effective drug against N. gonorrheae but it became ineffective in a span of 2 years. Penicillin then became the choice for gonorrhea treatment and remained so for decades. However, by 1989, mutations in the bacteria led to penicillin being no longer effective.

Subsequent to this, N. gonorrheae also became resistant to other antimicrobials like tetracycline, chloramphenicol, erythromycin and streptomycin. Today, third-generation cephalosporins are the only treatment recommended by the CDC for gonorrhea treatment.

Development of new antimicrobials and surveillance of bacterial strains in the population is therefore becoming essential to manage the spread of AMR gonorrhea and to understand resistance trends.

Innovations landscape

Some recent innovations in this regard are being led by CARB-X, the world’s largest public-private partnership dedicated to accelerating the development of products that address AMR.

Beyond funding, CARB-X partners with a Global Accelerator Network (GAN) to provide scientific, technical and business support to CARB-X’s product developers. C-CAMP is one of four CARB-X Global Accelerator Network members. As India’s premier bioinnovation hub, C-CAMP supports rapid molecular diagnostic platforms for the identification of microbial species and genes linked to AMR, machine learning algorithms for bacterial DNA analysis and for single-cell analysis.

Early diagnosis, development of new drugs and targeted use of antimicrobials are significant in AMR management in this disease.

CARB-X-backed entities like Talis innovation aim to develop high-performance rapid diagnostics — to diagnose gonorrhea and assess antibiotic susceptibility in less than 20 minutes.

Another entity, SpeeDx is developing a rapid PCR technology for gonorrhea detection, and Novel Microdevices aims to offer a rapid molecular test for gonorrhea in less than 25 minutes. Meanwhile, in the preclinical antimicrobial development space, Debiopharm is advancing a new orally active small molecule against gonorrhea. Venatorx and Microbiotix also have drug development programs directed against gonorrhea.

In addition, C-CAMP is leading initiatives like the Discovery to Innovation accelerator (DIA) which aims to break innovation barriers by connecting industry and academia to solve problems like AMR. The DIA platform is not only involved in the identification and assessment of discoveries but also its translation into proof of concept.

While AMR gonorrhea continues to be a threat that we need to look out for, these innovations have demonstrated some initial successes against AMR, and thus hold a lot of promise in shaping the future of therapeutics against this global health challenge.

Funding Support

In the current funding rounds led by CARB-X, three themes are supported: oral therapeutics, vaccines for neonatal sepsis, and gonorrhea products. The final deadline to submit an expression of interest is May 1.

For more information, visit the Apply section at CARB-X.org, watch the 40-minute video with comprehensive information on the application process, and read the regularly updated FAQ page.

Disclaimer: The blog is a compilation of information on a given topic that is drawn from credible sources; however, this does not claim to be an exhaustive document on the subject. It is not intended to be prescriptive, nor does it represent the opinion of C-CAMP or its partners. The blog is intended to encourage discussion on an important topic that may be of interest to the larger community and stakeholders in associated domains.

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