Gonorrhea, caused by Neisseria gonorrhoeae, is the second most common bacterial STI and results in substantial morbidity and economic cost worldwide. Gonorrhea is spread by having unprotected vaginal, anal, or oral sex with someone who has gonorrhea, or from mother-to-child during childbirth. Correct and consistent use of condoms significantly decreases the risk of sexual transmission.
Gonorrhea is often asymptomatic in women. If untreated, gonorrhea infection may lead to serious complications.
Of all the STIs, gonorrhea is the most antibiotic-resistant. Increased resistance to most antibiotics used to treat gonococcal infections has been reported worldwide, raising concerns about the eventual development of untreatable gonococcal infections with serious sexual and reproductive health consequences.
To the extent possible, countries should update their national guidelines for the treatment of gonococcal infection based on recent antimicrobial resistance (AMR) surveillance. If local ARM surveillance in not yet functional, PAHO urges countries to adopt the latest WHO treatment guidelines for N. gonorrhoeae.
- According to the Latin American AMR Surveillance Network (ReLAVRA), ciprofloxacin resistance has steadily grown, with isolates increasing from 35% in 2009 to 62% in 2015. Moreover, reduced sensitivity to broad spectrum cephalosporins and macrolides is beginning to emerge in Latin America and the Caribbean (LAC).
- While there are documented increases in gonococcal resistance to antimicrobial drugs, only 36% of the countries in the Americas systematically monitor this resistance to support treatment decisions
- In 2017, only 8% of the countries in LAC reported the use of ceftriaxone plus azithromycin, as recommended in the WHO treatment guidelines.
- The global response to STI is currently guided by the Global health sector strategy on sexually transmitted infections, 2016 - 2021
- The Plan of Action for the Prevention and Control of HIV and Sexually Transmitted Infections (2016-2021) provides lines of action for Member States and PAHO to enhance and expand the prevention and control of HIV and STIs in the Americas
- The Plan of Action for Antimicrobial Resistance (2015-2020) provides committed and coordinated support to the countries’ efforts to contain antimicrobial resistance
- PAHO’s Latin American Surveillance Network of Antimicrobial Resistance (ReLAVRA for its Spanish Acronym) aims at reporting the magnitude and trends of antimicrobial resistance in the Region, using routine data of microbiology laboratories
- WHO’s Gonococcal Antimicrobial Surveillance Programme (GASP) tackles this public health problem through a worldwide laboratory network that is coordinated by regional coordinating centers, including ReLAVRA
- In 2016, WHO developed the Guidelines for the Treatment of Neisseria gonorrhoeae providing updated recommendations for the treatment of gonorrhea based on the most recent evidence
- WHO and PAHO released, in 2018, a “Standard protocol to assess prevalence of gonorrhoea and chlamydia among pregnant women in antenatal care clinics” to support national and regional estimates of the burden of N. gonorrhoeae infections.
- And in 2020, PAHO launched a new guidance to support countries implementing and/or improving their antimicrobial resistance (AMR) surveillance of N. gonorrhoeae, integrated with the surveillance of gonorrhea infections
- PAHO facilitates and foster technical cooperation among countries, key partners and civil society organizations and provides direct technical assistance to countries to support the achievement of the elimination of priority sexually transmitted infections (STIs) as a public health problem by 2030