Women are more vulnerable than men to gonorrhea due to rising antibiotic resistance.

Don’t engage in sexual activity. It is “the only way to completely avoid STIs,” according to public health organizations. Avoid engaging in any oral, anal, or vaginal sex.

It is a sobering piece of wisdom. However, it also makes perfect sense when you look at the most recent data on the spread of antimicrobial resistance (AMR) and bacterial STIs, such as gonorrhea, from the European Centre for Disease Prevention and Control (ECDC).

Antibiotics including azithromycin, ceftriaxone, and cefixime are frequently used in medicine to treat gonorrhea, but their efficacy is declining. And that might be a factor in the rise in gonorrhea infections and STI cases in general throughout Europe, if not the world.

In a study released on June 10, 2024, the ECDC stated that there were 70,881 confirmed cases of gonorrhea in 28 EU/EEA (European Union/European Economic Area) nations in 2022, a 48% increase from the previous year.

AMR is one reason why antibiotics across the board — whether it’s for STIs or an earache — are failing public health efforts. Either we use them too much, or we don’t bother to take all the pills, with the result that bacteria are able to build up a resistance to many of our “go-to” drugs of the past 100 years.

Gonorrhea: What is it?
The Neisseria gonorrhoea bacteria is the cause of gonorrhea. It may impact the esophagus, rectum, or genitalia. Infections are common in young persons (ages 15 to 24).

Women are more likely than males to get an infection since diagnosis is more difficult for them. Women also frequently don’t have symptoms, and when they do, they are typically minor and can be confused for another vaginal or bladder infection. particularly expectant mothers, who may transmit STI infections to their fetus. Undiagnosed sexually transmitted infections can cause pregnancy problems in women or cause infertility.

However, men do experience symptoms, such as painful or enlarged testicles, a burning feeling when peeing, and a discharge that can be white, yellow, or green.

However, this is less common in women than it is in them. Teodora Elvira Wi, who oversees the global HIV, hepatitis, and STI programs at the World Health Organization in Geneva, stated that women must be given priority because they are asymptomatic.

“We need opportunities for women to be screened for STIs, and especially people at higher risk, people who have multiple partners and sexually active adolescents,” stated Wi.

‘Concerning’ antimicrobial resistance to popular medications for gonorrhea
In the ECDC paper, 4,396 gonorrhea samples (also known as “isolates”) from 23 different nations were analyzed. These samples were taken in 2022.

They discovered that “isolates resistant to azithromycin increased significantly to 25.6%, compared to 14.2% in 2021.”

Since azithromycin and ceftriaxone are frequently used together, the ECDC deemed this result to be “particularly concerning.”

Ciprofloxacin resistance rose as well, though not as dramatically: in 2022, 65.9% of isolates showed resistance, up from 62.8% in 2021.

Cefixime resistance remained “low at 0.3%.”

All things considered, the World Health Organization’s data from other regions—Africa and Asia, for example—reflects the ECDC figures.

According to Wi, 73 countries worldwide have reported antimicrobial resistance data in gonorrhea. “Antimicrobial resistance is not the only cause [there], but in countries where antimicrobial resistance is even higher than in Europe, it is contributing to the increase in bacterial STIs,” Wi added.

Pharyngeal (throat) gonorrhea was on the rise in 2022, according to ECDC data, although genital and anorectal gonorrhea cases stayed steady.

How to reduce STI transmission
According to WHO data from 2020, 374 million new cases of syphilis, gonorrhea, chlamydia, and trichomoniasis among individuals aged 15 to 49 occur worldwide each year. The increasing incidence of STI cases was attributed by the WHO to the following factors:

An increase in risky sexual conduct, such as the usage of fewer condoms and a rise in the number of casual and committed relationships

Socioeconomic factors and asymptomatic infections; biological considerations

Due to underfunding of services, there is a paucity of STI services, poor access to STI services, and a shortage of diagnostic test instruments.

Stigma: As a result of stigma, STI services and research are underfunded, and patients are less likely to seek treatment.

In public health initiatives to limit STIs, addressing and/or reversing these variables would be a smart place to start.

Wi advised against quitting entirely, saying that having sex should be accompanied by education. “Have sex, have pleasure in sex, make it a voluntary thing, do it for your sexual well-being and protect yourself the way you protect yourself from other infections,” she stated.

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