Gonorrhea resistance: don’t forget the old chaps

Excerpt

I read with great interest the paper by B. Suay-Garcia and M.-T. Pérez-Garcia on Neisseria gonorrhoeae and the resistance to antibiotics [1]. This echoes an over-anxiety generated by the WHO, the CDC and the media about the tragedy of resistance to gonococci, which leaves me unconvinced. Indeed, the tables reveal that there are different levels of resistance to gonococci according to countries, and that no country, for the time being, has observed gonococci that are resistant to everything. Also, a large number of antibiotics has not even been tested in vitro on gonococci as investigators are seeking newly discovered drugs rather than antibiotic compounds already known to be effective against N. gonorrhoeae. A rapid literature search identifies in 30 min at least three such compounds, which are probably effective in 100% of cases. These are pristinamycin [2], fusidic acid [3] and fosfomycin [4]. The real problem of gonorrhea, from my point of view, is to inform doctors in a given country about levels of resistance of gonococci in this area and the choice of an empirical treatment without culture, because it is the most used therapy. This means to test regularly isolates against an extended panel of antibiotics. In practice, in the one-day drama series, gonococcal infections are probably not the most terrifying, especially as treatment failure in gonococcal diseases can be evaluated within a few hours for symptomatic gonorrhea. Moreover, there are efficient drugs available and no need to scream before using these drugs that are cheap and should be as efficient as before [5]. …