Gonorrhea is becoming harder to treat due to rising antibiotic resistance. Data from 77 countries shows widespread resistance to older antibiotics, and emerging resistance even to cephalosporins, which are currently the last effective treatment. As a result, the WHO now recommends dual therapy using ceftriaxone and azithromycin. There is an urgent need to develop new antibiotics, as the research pipeline only has 3 candidate drugs. The WHO and GARDP are working to accelerate development of new treatments and ensure global access.

1. 7/12/2017 WHO | Antibiotic‐resistant gonorrhoea on the rise, new drugs needed
http://www.who.int/mediacentre/news/releases/2017/Antibiotic‐resistant‐gonorrhoea/en/ 1/4
Media centre
Antibiotic­resistant gonorrhoea on the rise,
new drugs needed
News release
7 JULY 2017 | GENEVA ­ Data from 77 countries show that antibiotic
resistance is making gonorrhoea – a common sexually­transmitted
infection – much harder, and sometimes impossible, to treat.
"The bacteria that cause gonorrhoea are particularly smart. Every time
we use a new class of antibiotics to treat the infection, the bacteria
evolve to resist them," said Dr Teodora Wi, Medical Officer, Human
Reproduction, at WHO.
WHO reports widespread resistance to older and cheaper antibiotics.
Some countries – particularly high­income ones, where surveillance is
best – are finding cases of the infection that are untreatable by all
known antibiotics.
"These cases may just be the tip of the iceberg, since systems to
diagnose and report untreatable infections are lacking in lower­income
countries where gonorrhoea is actually more common," adds Dr Wi.
Each year, an estimated 78 million people are infected with gonorrhoea*.
Gonorrhoea can infect the genitals, rectum, and throat. Complications of
gonorrhoea disproportionally affect women, including pelvic inflammatory
disease, ectopic pregnancy and infertility, as well as an increased risk
of HIV.
Decreasing condom use, increased urbanization and travel, poor
infection detection rates, and inadequate or failed treatment all
contribute to this increase.
Monitoring drug resistance
The WHO Global Gonococcal Antimicrobial Surveillance Programme
(WHO GASP), monitors trends in drug­resistant gonorrhoea. WHO
GASP data from 2009 to 2014 find widespread resistance to
ciprofloxacin [97% of countries that reported data in that period found
drug­resistant strains], increasing resistance to azithromycin [81%], and
the emergence of resistance to the current last­resort treatment: the
extended­spectrum cephalosporins (ESCs) oral cefixime or injectable
ceftriaxone [66%].
Currently, in most countries, ESCs are the only single antibiotic that
remain effective for treating gonorrhoea. But resistance to cefixime –
and more rarely to ceftriaxone – has now been reported in more than 50

2. 7/12/2017 WHO | Antibiotic‐resistant gonorrhoea on the rise, new drugs needed
http://www.who.int/mediacentre/news/releases/2017/Antibiotic‐resistant‐gonorrhoea/en/ 2/4
countries. As a result, WHO issued updated global treatment
recommendations in 2016 advising doctors to give 2 antibiotics:
ceftriaxone and azithromycin.
Development of new drugs
The R&D pipeline for gonorrhoea is relatively empty, with only 3 new
candidate drugs in various stages of clinical development:
solithromycin, for which a phase III trial has recently been completed;
zoliflodacin, which has completed a phase II trial; and gepotidacin,
which has also completed a phase II trial.
The development of new antibiotics is not very attractive for commercial
pharmaceutical companies. Treatments are taken only for short periods
of time (unlike medicines for chronic diseases) and they become less
effective as resistance develops, meaning that the supply of new drugs
constantly needs to be replenished.
The Drugs for Neglected Diseases initiative (DNDi) and WHO have
launched the Global Antibiotic Research and Development Partnership
(GARDP), a not­for­profit research and development organization,
hosted by DNDi, to address this issue. GARDP’s mission is to develop
new antibiotic treatments and promote appropriate use, so that they
remain effective for as long as possible, while ensuring access for all in
need. One of GARDP’s key priorities is the development of new
antibiotic treatments for gonorrhoea.
"To address the pressing need for new treatments for gonorrhoea, we
urgently need to seize the opportunities we have with existing drugs and
candidates in the pipeline. In the short term, we aim to accelerate the
development and introduction of at least one of these pipeline drugs,
and will evaluate the possible development of combination treatments
for public health use," said Dr Manica Balasegaram, GARDP Director.
"Any new treatment developed should be accessible to everyone who
needs it, while ensuring it’s used appropriately, so that drug resistance
is slowed as much as possible."
Gonorrhoea prevention
Gonorrhoea can be prevented through safer sexual behaviour, in
particular consistent and correct condom use. Information, education,
and communication can promote and enable safer sex practices,
improve people’s ability to recognize the symptoms of gonorrhoea and
other sexually transmitted infections, and increase the likelihood they
will seek care. Today, lack of public awareness, lack of training of
health workers, and stigma around sexually transmitted infections
remain barriers to greater and more effective use of these interventions.
There are no affordable, rapid, point­of­care diagnostic tests for
gonorrhoea. Many people who are infected with gonorrhoea do not have
any symptoms, so they go undiagnosed and untreated. On the other
hand, however, when patients do have symptoms, such as discharge
from the urethra or the vagina, doctors often assume it is gonorrhoea
and prescribe antibiotics – even though people may be suffering from
another kind of infection. The overall inappropriate use of antibiotics

3. 7/12/2017 WHO | Antibiotic‐resistant gonorrhoea on the rise, new drugs needed
http://www.who.int/mediacentre/news/releases/2017/Antibiotic‐resistant‐gonorrhoea/en/ 3/4
increases the development of antibiotic resistance in gonorrhoea as well
as other bacterial diseases.
“To control gonorrhoea, we need new tools and systems for better
prevention, treatment, earlier diagnosis, and more complete tracking and
reporting of new infections, antibiotic use, resistance and treatment
failures,” said Dr Marc Sprenger, Director of Antimicrobial Resistance at
WHO. “Specifically, we need new antibiotics, as well as rapid, accurate,
point­of­care diagnostic tests – ideally, ones that can predict which
antibiotics will work on that particular infection – and longer term, a
vaccine to prevent gonorrhoea.”
Notes to editors
This press release is based on two papers included in a special
supplement of PLOS Medicine to be published just before the STI & HIV
World Congress (http://www.stihivrio2017.com) taking place in Rio de
Janeiro, Brazil, 9–12 July 2017:
Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance
and a call for international collaborative action
Lead author: Dr Teodora Wi, WHO, Department of Reproductive
Health
Multidrug­resistant gonorrhoea: A research and development roadmap
to discover new medicines (PDF)
Lead author: Dr Emilie Alirol, GARDP/DNDi
At the STI & HIV World Congress, WHO will host a session on “Tackling
antimicrobial resistance in Neisseria gonorrhoeae: Need for a
comprehensive and collaborative approach”.
More about gonorrhoea
Global Antibiotic Research and Development Partnership (GARDP)
Global Action Plan on Antimicrobial Resistance
* Each year, an estimated 35.2 million people are infected in the WHO
Western Pacific Region, 11.4 million people in the WHO South­East
Asian Region, 11.4 million in the WHO African Region, 11.0 million in
the WHO Region of the Americas, 4.7 million in the WHO European
Region and 4.5 million in the WHO Eastern Mediterranean Region.
For more information, please contact:
Tarik Jašarević
Communications Officer, WHO
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
Email: jasarevict@who.int
Kimberly Chriscaden
Communications Officer, WHO
Telephone: +41 22 791 2885
Mobile: +41 79 603 1891
Email: chriscadenk@who.int

4. 7/12/2017 WHO | Antibiotic‐resistant gonorrhoea on the rise, new drugs needed
http://www.who.int/mediacentre/news/releases/2017/Antibiotic‐resistant‐gonorrhoea/en/ 4/4
Ilan Moss
Senior Communications Manager, DNDi (North America)
Telephone: + 1 646 616 8681
Mobile: +1 646 266 5216
Email: imoss@dndi.org
Jo Kuper
DNDi (Geneva)
Telephone: +41 22 907 7721
Mobile: +41 79 128 5241
Email: jkuper@dndi.org
Recent surveillance and
research
Antimicrobial resistance in
Neisseria gonorrhoeae: Global
surveillance and a call for
international collaborative
action
Multidrug­resistant gonorrhoea:
A research and development
roadmap to discover new
medicines (PDF)
More about gonorrhoea
WHO guidelines for the
treatment of Neisseria
gonorrhoeae
Scientists warn that antibiotic­
resistant gonorrhoea is on the
rise
Global action plan on AMR
Global Antibiotic Research and
Development Partnership
(GARDP)
Press briefing
Audio recording