World Health Organization calls for the adoption of updated guidelines for the management of chlamydial, gonococcal, and syphilitic infections

Dear Sir,

Sexually transmitted infections (STIs) have been acknowledged as one of the major public health concerns owing to its ubiquitous distribution, huge caseload, wide range of adverse health consequences, associated stigma or reluctance of people to avail health care services, and a massive burden on the health care delivery system.^[1],[2] In fact, the current global estimates suggest that more than 1 million STIs are acquired on a daily basis, of which majority are asymptomatic and often remains undetected and untreated.^[1]

Moreover, owing to the fact that these infections can have a serious long-term impact beyond the acute sufferings, like increase in the risk of acquisition of human immunodeficiency virus infection, pelvic inflammatory disease and infertility, cervical cancer, and transmission of the infection to newborn (which might result in stillbirth, neonatal death, low birth weight, congenital anomalies, neonatal conjunctivitis, etc.).^[1],[2] In addition, the low- and middle-income nations have been plagued by the problem of shortage in diagnostic tests, and even if it is available in some settings, its utilization is limited, either due to its expensive nature or due to the long time to obtain the results.^[1]

The current estimates suggest that more than 130, 75, and 5.5 million people are infected with chlamydia, gonorrhea, and syphilis respectively on an annual basis worldwide.^{[1],[3],[4],[5]} However, the health authorities have been presented with a major challenge of emergence of drug resistance (due to misuse or over use of drugs) for most of the STIs and it is anticipated that if no active interventions are taken, soon we will be starting to lose lives to these infections, which were preventable or treatable till now.^{[1],[3],[4],[5]}

Also, it is important to acknowledge that the cases of antibiotic resistance have been reported quite often in recent years, with the scenario being the worst for the gonococcal infection as multidrug resistant strains have been detected.^[3]

Nevertheless, resistance has even been reported for chlamydia and syphilis, and hence as a whole the prospects of prevention or prompt treatment is becoming unmanageable day by day.^[4],[5] Thus, there is a definitive risk for the rise in the incidence of long-term complications, making it further difficult for the patients.^[3],[4],[5]

In order to respond to the public health concerns of rise in the incidence of three major STIs amidst the background of the emergence of antibiotic resistance the World Health Organization (WHO) has released new guidelines for the treatment of all three of them.^[3],[4],[5]

However, at no stage, policy makers should neglect the practice of monitoring the patterns of antibiotic resistance within their health settings.^[3] In case of gonorrhea infection, a quinolone group of antibiotics have not been recommended, and the doctors have been advised to prefer those antibiotics against which no resistance has been reported in the local settings.^[3] For ensuring syphilis cure, a single dose of benzathine penicillin has been recommended.^[4] However, for different forms of chlamydial infections, either doxycycline or azithromycin administration has been advocated.^[5]

The WHO has called for all the nations to adopt the updated guidelines with immediate effect to further reduce the burden of antibiotic resistance.^[3],[4],[5]

Nevertheless, the best approach still remains the prevention of the acquisition of STIs, and hence correct and consistent use of condoms is the most effective method of protection.^[1] In addition, more emphasis on counseling and behavioral approach or expansion of diagnostic tools also offers the best prospects in improving the management practices of STIs.^[1],[2]

To conclude, chlamydia, gonorrhoea, and syphilis have been found to affect the quality of life of millions of people. Thus, it is the responsibility of the policy makers and the doctors to adopt the newly released guidelines and ensure that right antibiotic is offered in the right doses to minimize the risk of drug resistance and thus improve the overall sexual and reproductive health.

Acknowledgement

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1755-6783.222670