Gepotidacin, an antibiotic currently used to treat urinary tract infections, could be a new treatment to treat gonorrhoea, protecting against the threat of treatment-resistant gonorrhoea and improving patient treatment experiences, suggests the results of a phase 3 randomised control trial published in The Lancet and presented at the ESCMID conference.

Neisseria_gonorrhoea_in_pus_-_Gram_stain

Source: Dr Graham Beards

Neisseria gonorrhoea in pus from a man with a purulent urethral discharge - Gram stain

Gonorrhoea is a common sexually transmitted infection which if not treated promptly can result in serious complications, especially for women where it can lead to increased risks of ectopic pregnancy and infertility. Cases of drug-resistant gonorrhoea have increased rapidly in recent years, reducing the options for treatment. There is an urgent need for new treatments for gonorrhoea with no new antibiotics since the 1990s.

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This trial of 622 patients compared a potential new treatment for uncomplicated gonorrhoea (gepotidacin - an oral pill) with the current standard treatment (ceftriaxone - an injection, and azithromycin - a pill) and found the new pill to be as effective as the current standard treatment at treating the infection. Crucially, the new pill was effective against strains of the gonorrhoea bacteria that are resistant to existing antibiotics. There were no treatment-related severe or serious side effects for those treated with either medication.

Important tool

Authors say the new treatment could be an important tool in combating the rise of gonorrhoea strains that are becoming resistant to the standard treatment. Additionally, treatment as a pill alone without the need for an injection would likely improve patient experiences and reduce healthcare resources. However, authors also caution that this study looked primarily at urogenital gonorrhoea and that most of the study group were white men, therefore more research is needed to see the impact of the new treatment on gonorrhoea of the rectum and throat, and in women, adolescents, and diverse ethnicities.

An Editorial titled ‘Stopping gonorrhoea’s descent towards untreatability’ published in The Lancet Infectious Diseases at the same time as The Lancet article says, “What we are seeing with N gonorrhoeae is a challenge that could extend easily to other bacteria with worsening of the antimicrobial resistance landscape. Investment in research for new antimicrobials and efficacious prevention methods are key to prevent gonorrhoea from getting out of control in the coming years.”

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