A strain of the sexually transmitted infection gonorrhoea is showing increasing resistance to the usually prescribed antibiotics, causing the medical profession to fear that soon there will be no treatment for the disease.

Also called the clap or drip, gonorrhoea is a very common disease, particualrly among young people aged 15-24. Prevalence figures were not immediately available for Jamaica, but the Centers for Disease Control and Prevention (CDC) reports that there are as many as 700,000 new cases in the US each year, with less than half of them reported to the CDC.

According to Dr Alison Nicholson from the Department of Microbiology at The University of the West Indies, neisseria gonorrhoeae, the bacteria that causes the infection, has learnt all the “tricks of anything you can bring and now it’s not impressed by any of the drugs”.

“At this stage, a strain of the infection is showing resistance to antibiotics. The fear is that someone will turn up with that strain and it can’t be treated,” she said.

But worse than that, no new drugs are being developed.

“The worst problem is that nothing new is being developed in the pipeline that’s immediately available, so we will have a lag when there’s nothing to do. It takes 10 years to develop a new drug at an estimated cost of US$800 million.

“Pharmaceutical companies have stopped making antibiotics, a number of them. The issue is that the bugs are becoming resistant so fast that they will develop resistance before 10 years, and it takes 10 years to develop a drug, so, you will stop using [their] drugs. Instead, they are concentrating on doing things for pain, diabetes, etc. Those are captive patients; you will always have those patients with you. An infection on average is seven to 10 days treatment. If the bug becomes resistant — no treatment. So, bugs are developing resistance and new antibiotic production is decreasing — we are caught in that,” Nicholson said.

She was speaking last Friday at an antibiotic resistance communication workshop put on by the Caribbean Institute of Media and Communication (CARIMAC) in partnership with the Faculty of Medical Sciences to inform journalists, health workers and the public about the establishment of a national programme to address the emergence of antibiotic resistance (ABR) in Jamaica.

The workshop came out of a three-year project which started in 2014 using a multidisciplinary method to develop national guidelines about proper antibiotic use as well as curriculum material for core courses for doctors and journalists on the issue. Public messages are expected to be released in the media next year.

ABR also has implications for epidemics such as tuberculosis, cholera, bacterial pneumonia, bubonic plague, and pneumonic plague, which killed millions in the pre-antibiotic era. Without new, more effective drugs added to the dispensary, a return to those times could be imminent, with a possibility of causing 10 million deaths worldwide by 2050.

“We do not want people to be frightened, but it’s very real,” Nicholson said Friday.

“People are merrily going about taking their antibiotics, taking things for granted and we want to sound the alarm and say it’s serious. Wake up! We have a disaster looming. The organisms have learnt the secret of the antibiotics that are available and they have become resistant to the antibiotics, and one person from the CDC has gone on record saying we are now in the post-antibiotic era and we have no alternative, so it’s important for everybody to get on board,” she continued.

Dr Nicholson explained that the consequences of antibiotic resistance will mean that patients will either die because they can’t get proper treatment, stay longer in hospitals, face more expenses, or be refused treatment such as organ transplants and chemotherapy because they make patients prone to infection.

“When you don’t have anything to treat them with how are you to give chemotherapy knowing an infection is possible? A lot of the advances made in modern medicine, the success of these have been predicated on the availability of antibiotics,” she argued.

As a result, a national action plan against ABR is expected to be available locally in 2017 to increase awareness and effect behaviour change among the population as it relates to the proper usage of antibiotics.

“In 2015 the World Health Organization (WHO) had an assembly meeting in Geneva and developed a global action plan against ABR. The United Nations General Assembly also convened an extraordinary meeting to talk about ABR and mandated that all member countries should develop a national action plan by 2017. Everybody is waking up to this challenge we face. ABR has taken centre stage and is no longer a scientific problem but a political issue and a threat to global health,” she pointed out.

Dr Nicholson pointed out that the development of the action plan, which should show a five-year projection, is being led by the ministries of health and finance and should include a one-health approach to ABR.

“Sometimes we only think of doctor and patient when it comes to antibiotic use but vets use antibiotics too, so it has to be done comprehensively. It also involves antimicrobial stewardship, which is a set of guidelines to help you to know how to prescribe antibiotics, restricting use of certain antibiotics, pulling back when necessary and growing awareness and commitment politically, professionally and from the public,” she said.

Dr Nicholson added: “ It could feel like an impossible task because we are so entrenched in our antibiotics but we have to get the message out. We can’t prevent ABR, but we can slow it down by using antibiotics properly and give ourselves a few more years of antibiotics while new ones are developed.”

Clive Harris, who represented the CEO of the National Health Fund — which provided funding to the tune of $10 million for the ABR project —said he was pleased with the progress being made.

“This is a research project relevant to our population. There is upwards of 101,000 prescriptions per month, so you can imagine the amount of antibiotics being prescribed in the health institutions and the level of usage there and the chance for misuse and ABR to develop,” he said.

Professor John Lindo from the Faculty of Medical Sciences said ABR has been described by the WHO as one of the health crises of our times. “We are marching to the end of our antibiotics, so teams such as these are important; we have no choice. The job that the team has taken on is a mammoth path. It’s a path that requires changed behaviour among physicians [and other] persons,” he said.