Antibiotic Resistance in Neisseria gonorrhoeae: Will Infections be Untreatable in the Future?

Gonorrhea is the most common sexually transmitted disease (STD) in the world and it’s making a comeback due to emerging antimicrobial resistance (AMR). Physicians can no longer use a single magic bullet (i.e. an antibiotic) to cure the disease; they now must use a combination of antibiotics. New strategies are needed to ensure that we can control and cure this widespread infection; for example, a fast, effective detection kit for the pathogen and its antibiotic resistance and a safe, effective vaccine. Almost all of my research, whether it’s public health-oriented and dealing with the frequency of and molecular epidemiology of gonococcal antimicrobial resistance in various regions around the world, or more basic research on mechanisms of antimicrobial resistance, connects to an overall theme of antimicrobial resistance. I developed a passion for studying bacteria at a time when DNA technology was rapidly evolving and have sought to integrate new technologies with public health microbiology. I also study bacterial cell division mechanisms in N. gonorrhoeae and other microorganisms.

There is a resurgence of interest in the area of antimicrobial resistance, mechanisms of resistance and the identification of new effective agents or approaches for treating gonococcal infections. There is recognition that this is a global problem and the WHO has led an initiative to control the spread of antibiotic resistant N. gonorrhoeae that will lead to profound impacts in public health capacity building, public health policy, and innovative diagnostic and prevention approaches for sexually transmissible infections.

My job is multi-focal. It involves teaching, training, mentoring, research, as well as the provision of technical and policy advice. I love the complexity of what I do and I especially enjoy my interaction with people from all areas of the health care spectrum. I am so proud of my students and trainees who have gone on to significant roles in research and public health leadership in Canada and around the world.

First I feed my cats and appreciate the beauty of Saskatchewan countryside. Then, my typical day would comprise teaching undergraduate or graduate students in formal university courses; consulting and advising people in my own laboratory regarding on-going projects; perhaps a seminar in which I speak about my research; responding to a myriad of emails regarding on-going projects, future meetings and collaborations; writing grants, papers, and articles; consultation with public health authorities; and, planning for travel (e.g. to visit various GASP laboratories in Latin America and the Caribbean).

For the next few years, I will be concentrating on my various research projects in the area of gonococcal antimicrobial resistance and its detection. I will be working with health care researchers from a variety of different regions from around the world and within the province of Saskatchewan to gain a better perspective of the burden of gonococcal resistance both locally and internationally. I hope to be able to work with colleagues to improve infrastructure to diagnose N. gonorrhoeae and its antibiotic resistance. 

There has been significant international publicity about the problem of potentially untreatable gonococcal infections. The issue has been highlighted by initiatives and national strategies to combat this resistance in various countries. Many countries have called together their medical officers of health from various regions to discuss the problem. Nevertheless, I am sometimes amazed at how difficult it is to communicate the extent of the problem to health care givers working in the trenches. Also, in some cases, despite evidence that isolates may be resistant to various antibiotics in a region, it has proven to be quite a challenge for local authorities to modify and communicate new effective treatment guidelines. Further, the need for capacity building, which entails rebuilding laboratory infrastructures and extensive training, has presented significant challenges as well.

There is a clear need to increase laboratory capacity for the culture, diagnosis and susceptibility testing of N. gonorrhoeae in many countries. Alarmingly, this capacity has actually declined as syndromic management of gonococcal infections became policy in many regions. Thus the treatment of gonorrhea has been based on empirical guidelines. Without an adequate laboratory and surveillance infrastructure, there may be a real lack of knowledge of the extent of gonococcal antimicrobial resistance present. Treatment guidelines may recommend antibiotics to which the organism is resistant and it has been extraordinarily difficult for some regions to implement changes to treatment guidelines in a timely fashion. As well, clinical research regarding effective new antimicrobials and new antibiotic combinations for treatment are urgently needed. One could also ask whether the time is ripe to take a renewed interest in plant extracts as a source of novel antimicrobial agents.