Due To Antibiotic Resistance, WHO Updates Treatment Guidelines for Three STIs

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1 Sep 2016 - General

 WHO releases new treatment guidelines for chlamydia, gonorrhoea and syphilis, saying the updates respond to an "urgent need" in light of increasing antimicrobial resistance. The most resistant strains are found to be gonorrhea more than chlamydia or syphilis. According to the WHO, more than 1 million STIs are acquired every day worldwide. Each year, an estimated 131 million people are infected with Chlamydia, 78 million with gonorrhea, and 5.6 million with syphilis. Antibiotic resistance to these STIs has increased rapidly in recent years and has reduced treatment options.

 Curbing the incidence rates of these STIs and preventing their complications is imperative to preserve the productive health and the quality of life of the population.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 updates aim to pick the correct antibiotic choice with the suitable dosing within the correct timing. WHO says it looked for treatments that offered high efficacy and quality while keeping in mind cost, toxicity, route of administration, as well as the likelihood for resistance to the treatments developing.

Neisseria Gonorrheae:

 The agency says it no longer recommends treating gonorrhea with quinolones "due to widespread high levels of resistance." The new guidelines include specific recommendations for oropharygeal infections and retreatment of gonococcal infections after treatment failure. They also note that dual therapy is a preferred option for treatment of gonococcal infections over single therapy. Single therapy is based on local resistance data, and changes have been made to some dosages. In addition, new topical medications have been suggested for prophylaxis against ophthalmia neonatorum.

Generally, the WHO recommends that health authorities track the prevalence of resistance to different antibiotics in the strains of gonorrhea circulating among their population and advise doctors to prescribe whichever antibiotic would be most effective, as determined on the basis of local resistance patterns.

Treponema Pallidum (Syphilis):

 For syphilis, the new WHO guidelines recommend a single intramuscular injection of benzathine penicillin G 2.4 million units for adults and adolescents with early syphilis. "This is the most effective treatment for syphilis; more effective and cheaper than oral antibiotics," the WHO says.
Benzathine penicillin was recognized by the Sixty-ninth 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 3 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 Trachomatis:

 It is the commonest of the three infections, WHO is conditionally recommending a number of antibiotic regimens, leaning heavily on dual therapies involving azithromycin and a second antibiotic, such as erythromycin or doxycycline as first-line therapies for most patients, with specific recommendations for pregnant women and infants.


WHO is calling on countries to start using the updated guidelines immediately, as recommended in the "Global Health Sector Strategy for Sexually Transmitted Infections (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.


Thanks for the helpful information Mahmoud AbdelAziz . The problem on antibiotic resistance is emerging and the effects of which are becoming evident already. I think these guidelines are helpful but local patterns of resistance should be investigated first prior to making adjustments in clinical practice. If there are available biograms within the hospital or there is an infectious committee within the healthca...
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