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[e-drug] Growing antibiotic resistance forces updates on treatment for STIs

E-DRUG: Growing antibiotic resistance forces updates on treatment for STIs
[Thanks to Lucas for spotting. WB]

News Release WHO/28

Growing antibiotic resistance forces updates to recommended treatment for 
sexually transmitted infections

WHO releases new treatment guidelines for chlamydia, gonorrhoea and syphilis


30 AUGUST 2016 | GENEVA:  New guidelines for the treatment of three common 
sexually transmitted infections (STIs) have been issued by the World Health 
Organization (WHO) in response to the growing threat of antibiotic resistance.

Chlamydia, gonorrhoea and syphilis are all caused by bacteria and they are 
generally curable with antibiotics. However, these STIs often go undiagnosed 
and they are becoming more difficult to treat, with some antibiotics now 
failing as a result of misuse and overuse. It is estimated that, each year, 131 
million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 
million with syphilis.

Resistance of these STIs to the effect of antibiotics has increased rapidly in 
recent years and has reduced treatment options. Of the three STIs, gonorrhoea 
has developed the strongest resistance to antibiotics. Strains of 
multidrug-resistent gonorrhoea that do not respond to any available antibiotics 
have already been detected. Antibiotic resistance in chlamydia and syphilis, 
though less common, also exists, making prevention and prompt treatment 

When left undiagnosed and untreated, these STIs can result in serious 
complications and long-term health problems for women, such as pelvic 
inflammatory disease, ectopic pregnancy and miscarriage, and untreated 
gonorrhoea and chlamydia can cause infertility in both men and women. Infection 
with chlamydia, gonorrhoea and syphilis can also increase a person's risk of 
being infected with HIV two to three fold. An untreated STI in a pregnant woman 
increases the chances of stillbirth and newborn death.

“Chlamydia, gonorrhoea and syphilis are major public health problems worldwide, 
affecting millions of peoples'  quality of life, causing serious illness and 
sometimes death. The new WHO guidelines reinforce the need to treat these STIs 
with the right antibiotic, at the right dose, and the right time to reduce 
their spread and improve sexual and reproductive health. To do that, national 
health services need to monitor the patterns of antibiotic resistance in these 
infections within their countries,” says Ian Askew, Director of Reproductive 
Health and Research, WHO.

The new recommendations are based on the latest available evidence on the most 
effective treatments for these three sexually transmitted infections.


Gonorrhoea is a common STI that can cause infection in the genitals, rectum, 
and throat. Antimicrobial resistance has appeared and expanded with every 
release of new classes of antibiotics for the treatment of gonorrhoea. Because 
of widespread resistance, older and cheaper antibiotics have lost their 
effectiveness in treatment of the infection.

WHO urges countries to update their national gonorrhoea treatment guidelines in 
response to the growing threat of antibiotic resistance. National health 
authorities should track the prevalence of resistance to different antibiotics 
in the strains of gonorrhoea circulating among their population. The new 
guideline calls on health authorities to advise doctors to prescribe whichever 
antibiotic would be most effective, based on local resistance patterns. The new 
WHO guidelines do not recommend quinolones (a class of antibiotic) for the 
treatment of gonorrhoea due to widespread high levels of resistance.


Syphilis is spread by contact with a sore on the genitals, anus, rectum, lips 
or mouth, or from mother to child during pregnancy. If a pregnant woman has 
untreated syphilis and the infection is transmitted to the fetus, this often 
causes it to die. In 2012, mother-to-child transmission of syphilis resulted in 
an estimated 143 000 early fetal deaths/stillbirths, 62 000 neonatal deaths and 
44 000 babies being born preterm/low-birth-weight.

To cure syphilis, the new WHO guideline strongly recommends a single dose of 
benzathine penicillin - a form of the antibiotic that is injected by a doctor 
or nurse into the infected patient's buttock or thigh muscle. This is the most 
effective treatment for syphilis; more effective and cheaper than oral 

Benzathine penicillin was recognized by the 69th World Health Assembly in May 
2016 as an essential medicine which has been in short supply for several years. 
Reports of stock outs have been received by WHO from antenatal care 
representatives and providers in countries with high burdens of syphilis from 
three WHO Regions. WHO is working with partners to identify countries with 
shortages and help monitor global availability of benzathine penicillin to 
close the gap between national needs and supply of the antibiotic.


Chlamydia is the most common bacterial STI and people with this infection are 
frequently co-infected with gonorrhoea. Symptoms of chlamydia include discharge 
and a burning feeling when urinating, but most people who are infected have no 
symptoms. Even when chlamydia is asymptomatic, it can damage the reproductive 

WHO is calling on countries to start using the updated guidelines immediately, 
as recommended in the Global Health Sector Strategy for STIs (2016-2021) 
endorsed by governments at the World Health Assembly in May 2016. The new 
guidelines are also in line with the Global Action Plan on Antimicrobial 
Resistance, adopted by governments at the World Health Assembly in May 2015.

When used correctly and consistently, condoms are one of the most effective 
methods of protection against STIs.
For more information, please contact:

Gregory Hartll, 
WHO Department of Communications, 
Telephone: +41 22 791 44 58, 
Mobile: +41 79 203 67 15, 
Email: hartlg@who.int
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