AMR ticking timebomb: Drug-resistant gonorrhea outbreak in Kenya major fertility threat, researchers warn

Gonorrhoea is the second-most common disease to be sexually transmitted across the world

By Tony Malesi
Published: Monday 16 January 2023
Neisseria gonorrhoeae bacteria. Photo: iStock__

A strand of antimicrobial-resistant gonorrhoea outbreak has hit Kenya, according to researchers at the Kenya Medical Research Institute (Kemri).

The medics said the drug-resistant super gonorrhoea was first detected in samples taken from sex workers in the capital city, Nairobi, and other urban areas like Kiambu County.

The medical investigation was prompted by reports by medics indicating there was a surge in cases of patients seeking treatment for sexually transmitted infections (STI) late last year, Dr Amina Abdullahi, one of the researchers who made the discovery at the globally revered research institution, told the local press. 

Researchers have raised alarm, warning that many Kenyans are carrying the incurable infection that is asymptomatic in some cases and can cause significant health challenges, including permanent damage to their reproductive systems.

DTE Coverage: World Antimicrobial Awareness Week 2022

The outbreak of Neisseria gonorrhoea is not just a threat to the citizens of the East African anchor state but the region as a whole, according to experts. 

Most of the infected female sexworkers, who interact with men from across East Africa owing to Nairobi’s status as a regional commercial hub and in the spirit of the East Africa Community that allows free intercountry movement, did not even have the clinical symptoms of Neisseria gonorrhoea, said Dr Abdullahi, adding:

We tested the isolated bacterium against over 13 antimicrobials, which comprise the mainstay antibiotics for the disease in Kenya and East Africa. The result showed complete resistance to all the antimicrobials.

Some of the drugs that got 100 per cent resistance included ciprofloxacin and ceftriaxone, which are in the current STI treatment algorithm in Kenya.

Gonorrhoea is the second-most common disease to be sexually transmitted across the world after chlamydia, according to the World Health Organization (WHO).

The United Nations health agency blamed the drug resistance of some strands of gonorrhoea on the overuse of antibiotics, genetic mutations of the bacteria and repeated use of poor-quality drugs, in its regular reports.

“The emergence of different strands of resistance in an STI like gonorrhoea often results in the rapid spread of the ailment. The effects can be felt in neighbouring countries, but they are more disproportionate in low and middle-income countries with underdeveloped health systems,” said Dr Teodora Wi, a medical officer with WHO and STI specialist.

Kenya’s infertility prevalence is estimated to be 11.9 per cent, show documents by Kenya’s ministry of health, including The Kenya National Guidelines for Prevention, Management, and Control of STIs. The country’s infertility is likely to increase with the outbreak of drug-resistant gonorrhoea and other eventual STIs, researchers at Kemri and other medical experts have warned. This can have devastating effects on the country’s development agenda, they added.

Read more: Health system inequalities in East Africa drive antimicrobial resistance

Dr Catherine Ngugi, who is a former National AIDS and STIs Control Programme (Nascop) director, expressed concern over rising cases of infertility due to STIs.

“In the last two years, medics have noted with concern an increase in chlamydia and gonorrhoea among people aged 15-24 years. Someone can have chlamydia for months or even years before it is detected. It’s a silent infection and asymptomatic in most people,” Dr Ngugi said.

In sub-Saharan Africa, infertility is caused by STIs in more than 85 per cent of women compared to 33 per cent worldwide, according to WHO.

Other countries with good STI surveillance such as the United States and Canada have reported an increase in at least three STIs: Syphilis, gonorrhoea and chlamydia.

Many countries had reported low coverage for preventive, testing and treatment services related to STIs during the last three years of the COVID-19 pandemic, which has led to a resurgence of such infections and the emergence of non-classical STIs globally, according to the WHO.

The outbreak is a major concern among health practitioners, especially happening at a time WHO endeavours to end STIs as a public health concern by 2030.

The global health body has made calls on countries to increase funding for STI services and focused efforts to scale up STI prevention, testing and treatment in a bid to boost reproductive health — a major pillar in national and regional development agenda.

Drug resistance is a big concern and efforts have to be deployed to save and boost the country and region’s reproductive health, Dr Joseph Murithi, a senior officer at the Pharmaceutical Society of Kenya, said. “This is a major concern because not many novel antibiotics are being manufactured.”

“Late last year I had a patient who had used over 21 different antibiotics for a urinary tract infection in vain,” Dr Murithi added. Antibiotic resistance is a big problem that needs researchers’ attention, he noted.

Other diseases that medics have expressed concern over due to total antimicrobial resistance include various strains of SARS-CoV-2, ebola virus disease, Crimean-Congo hemorrhagic fever, Lassa fever and marburg virus disease.

The same has been reported regarding some strains of Middle East respiratory syndrome coronavirus, Rift Valley fever, severe acute respiratory syndrome, Nipah and henipaviral diseases.

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