GPs are prescribing antibiotics that no longer work for people with gonorrhoea, raising the chances that drug-resistant forms of the sexually transmitted disease will spread.
Antibiotics are losing their potency against many infectious diseases because of inappropriate use or overuse. Gonorrhoea, a serious sexually transmitted infection that is easily passed on and can cause infertility, has for some time been a cause for concern. The bacterium that causes it, Neisseria gonorrhoeae, has developed resistance to the antibiotic ciprofloxacin, traditionally used to treat it, so that in a third of cases, it no longer works.
But a study led by Public Health England (PHE), published in the journal BMJ Open, shows that many GPs are still giving their patients ciprofloxacin, even though it has not been recommended for treatment since 2005. In 2007, ciprofloxacin was on 42% of prescriptions for gonorrhoea and even as recently as 2011, it was still prescribed in 20% of cases.
“We know that gonorrhoea is resistant to quite a lot of antibiotics and does develop resistance quite rapidly to new antibiotics as well,” said lead author Dr Gwenda Hughes from PHE. “The problem is obviously that if people are prescribing the wrong antibiotics, the patient won’t be effectively treated. That isn’t true for all patients – some will still be sensitive to that antibiotic – but some will have an infection that will be resistant to it and that infection will be disseminated more widely.”
Strains of the disease that are resistant to one antibiotic may also be resistant to a newer one in the same class. Since the study was completed, the treatment guidelines have changed again. Cefixime, which was the recommended antibiotic until 2011, has now been dropped because of resistance in favour of ceftriaxone, which is a similar drug that is administered by injection, which some patients may not want.
“We’re really concerned with this shift that it might be even less likely that people will follow the guidance,” said Hughes.
Treatment for gonorrhoea – once known as “the clap” – is complex because patients must be treated with the latest recommended drugs but also be tested afterwards to ensure that the infection has been cleared. It is also important that any sexual partners are notified and that the patient is encouraged to have tests for other sexual infections, including HIV. Hughes says that some GP practices will be in a position to do all this, but those that are not should refer patients to a specialist sexual health clinic.
There are some potential antibiotics to treat gonorrhoea on the horizon, but, said Hughes, “We really need to prolong the use of the existing drugs we have and ensure we have good stewardship of the antibiotics we have and we are not treating people with drugs where there are high levels of resistance.”
The study looked at the diagnosis and treatment of both gonorrhoea and chlamydia in GP surgeries between 2000 and 2011. The two diseases are the most common sexually transmitted infections, with 28,594 cases of gonorrhoea diagnosed in the UK in 2012 and 237,675 cases of chlamydia. There are few problems with the successful treatment of chlamydia.
