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Rumbidzayi Zinyuke, Health Buzz
Sexually Transmitted Infections have been around for many years.
However, over the past years, the diseases have evolved, causing a headache for health sectors all over the world.
One such disease is gonorrhoea, a sexually transmitted infection (STI) caused by Neisseria gonorrhoea, which has gradually become a pressing public health concern.
Zimbabwe is not spared.
According to the 2023 Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) report findings, over 10 500 cases of male urethritis were reported between 2015 to 2023.
In 2023 data from 3498 urethritis episodes in male patients were reported from nine EGASP participating countries.
Of these, 786 (22 percent) were from The Philippines, 762 (22 percent) from Thailand, 528 (15 percent) from South Africa, 423 (12 percent) from Uganda, 380 (11 percent) from Cambodia, 260 (7 percent) from Viet Nam, 126 (4 percent) from Indonesia, 126 (4 percent) from Malawi and 107 (3 percent) from Zimbabwe.
The growing challenge lies in the emergence of drug-resistant gonorrhoea strains, which fail to respond to the antibiotics traditionally used to treat the infection.
This phenomenon, referred to as antimicrobial resistance (AMR), has been observed globally Zimbabwe included.
The EGASP report showed that resistant strains have been spreading with strains such as penA-60 and penA-34 linked to ceftriaxone resistance were spreading internationally.
It showed that resistance to ceftriaxone increased from 0,8 percent in 2022 to 4 percent in 2023, while resistance to cefixime increased from 1,7 percent to 9 percent and resistance to azithromycin increased from 0,5 percent to 4 percent during the same period.
“Antimicrobial resistance in gonorrhoea risks turning a treatable infection into a major global health threat, highlighting the urgent need for continuous surveillance,” the report noted.
While the figures may seem low to the ordinary person, the implication of such a situation could spell disaster for most developing countries that have limited capacity to deal with such a public health challenge.
Recent reports from the Ministry of Health and Child Care have highlighted a troubling surge in gonorrhoea cases, especially among young adults and urban populations.
Drug resistant strains have also been on the rise. The disease, primarily spread through unprotected sexual contact, causes symptoms such as painful urination and abnormal genital discharge.
Left untreated, gonorrhoea can lead to severe complications, including infertility, pelvic inflammatory disease, and an increased risk of HIV transmission.
The implications
Gonococcal infections have critical implications to reproductive, maternal and new-born health including a five-fold increase of HIV transmission, infertility, with its cultural and social implications, inflammation leading to acute and chronic lower abdominal pain in women, ectopic pregnancy and maternal death as well as severe neonatal eye infections that may lead to blindness.
Antimicrobial resistance increases this burden by prolonging the infection in more people and increasing the number of people with long-term complications of gonococcal infections.
Since it can be difficult to find complete information from areas with limited resources for surveillance, the antimicrobial resistance is expected to be much higher than what is currently seen due to silent spreading.
Why drug resistance is rising
Experts attribute the rise of drug-resistant gonorrhoea to several factors that include the overuse and misuse of antibiotics.
This is often a result of self-medication and the improper use of antibiotics, which are widespread in Zimbabwe due to the high cost of healthcare and limited access to services in some areas.
There has also been a rise in cross-border infections as the country shares porous borders with neighbouring countries, facilitating the spread of resistant strains across populations.
Stigma and lack of awareness is also a major cause of concern as many people do not seek timely treatment for STIs due to stigma, allowing the infection to persist and adapt to available drugs.
The World Health Organisation has warned that gonorrhoea could soon become untreatable if new antibiotics are not developed.
In the meantime, the health body is implementing the Global Action Plan to Control the Spread and Impact of Antimicrobial Resistance in N gonorrhoea to facilitate effective actions against the spread of multi-drug resistant gonorrhoea.
This is part of the greater STI surveillance plan to help early detection of emerging resistant strains, combined with a public health response to prevent and treat gonococcal infections and reduce the impact of gonorrhoea on sexual and reproductive health.
The Global Health Sector Strategy on HIV, Hepatitis and STIs (2022–2030) has set targets to reduce the number of new cases of gonorrhoea among people aged 15–49 years old from 82,3 million per year in 2020 to 8,23 million per year in 2030. This translates to reducing the year incidence by 90 percent by 2030.
“Recognising that this reduction may be difficult to achieve with available interventions, and given increasing antimicrobial resistance, the strategy has emphasised the need to develop effective gonococcal vaccines.
“No currently licensed gonococcal vaccines exist. However, interest in gonococcal vaccine development has been reinvigorated not only by the marked increases in gonococcal antimicrobial resistance, but also by mounting scientific evidence suggesting gonococcal vaccines are biologically feasible,” says the WHO.
Raising awareness and addressing the issue
The fight against drug-resistant gonorrhoea requires a multi-faceted approach.
This should include education campaigns that include public health initiatives focusing on raising awareness about safe sexual practices, the dangers of self-medication, and the importance of seeking medical care for STIs.
Strengthening healthcare infrastructure and making diagnostic and treatment services affordable and accessible is also critical.
There is also need for enhanced antibiotic stewardship where medical practitioners are trained on proper prescribing practices to minimise the misuse of antibiotics.
There is also need for enhanced surveillance. This involves investing in laboratory facilities to monitor the prevalence and resistance patterns of gonorrhoea is essential for informed policymaking.
Above all, the community plays a major role in combating this public health challenge.
Community leaders, educators, and religious institutions must also play an active role in destigmatising sexual health discussions.
Open dialogue can encourage individuals to seek help early and prevent the silent spread of the infection.
Drug-resistant gonorrhoea is a silent but rapidly growing threat, exacerbated by systemic healthcare challenges and social stigma.
Without urgent action, the world risks facing a public health crisis.
Addressing this issue requires a concerted effort from the Government, health professionals, and communities to ensure that education, prevention, and treatment remain at the forefront of public health priorities.
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