SPC: Strengthening Initiatives Against Drug-Resistant Gonorrhea in the Pacific


Suva, Fiji – The Secretariat of the Pacific Community (SPC) is at the forefront of efforts to improve the laboratory skills of technicians to identify and report gonorrhoea strains and their susceptibility to anti-microbial agents.

Tebuka Toatu, laboratory specialist in the HIV and STI section of SPC’s Public Health Division, said that two workshops will be held for laboratory technicians later this year.

The workshops, one for the northern and one for the southern Pacific, are supported by the Pacific HIV and STI Response Fund, an AusAID and NZAID-funded initiative, managed by SPC. They come at a time when the World Health Organization reported that gonorrhoea is becoming a major public health challenge, with the disease having developed resistance to virtually every class of antibiotic available at present.[i]   

[Laboratory Scientist, Mr Richard Malili, at Vila Central Hospital, Vanuatu, operating a BD Probe Tec Analyser, used to detect DNA particles specific for the bacteria-causing gonorrhoea. Laboratories are now putting in place and strengthening the culture methods for the detection of this bacteria.]

‘Resistant strains of gonorrhoea can occur if medication is given inappropriately. A lot of drugs are used to treat gonorrhoea but some may not kill the bacteria and this can lead to resistance. Also, patients sometimes do not finish the course of antibiotic treatment, and this, too, can lead to strains becoming resistant,’ Mr Toatu said.

He added that, as a part of being proactive throughout the Pacific region in meeting the challenge, laboratories need to be able to detect whether or not antibiotics are working. The workshops will help ensure that accurate and reliable testing processes are either implemented or strengthened, and that there is adherence to microbiology quality controls and standards.

‘The workshops will address the all-important aspects of laboratory quality management systems, including testing processes and the documentation of those processes, the number of qualified staff and their capacity. The aim is to assist SPC members with capacity building and the implementation of laboratory management systems where required,’ said Mr Toatu.

Mr Toatu attributes part of the problem of rising drug-resistant gonorrhoea rates to the use of only one testing methodology — polymerase chain reaction (PCR) — where urine is used to detect DNA particles that are specific to the bacteria that cause gonorrhoea.

‘Although this testing methodology is very sensitive and specific, it lacks the capacity to determine antimicrobial susceptibility patterns. It is important to do this in order to determine treatment failure and to evaluate the effectiveness of current recommended therapies used to treat gonorrhoea.[ii]

In addressing this issue, countries can maintain the PCR testing methodology but should also use the culture method and collect urethral swabs from men and endocervical swabs from women who present with signs and symptoms of gonorrhoea in order to monitor the susceptibility pattern of gonorrhoea in a community,’ said Mr Toatu.

Gonorrhoea is one of the most common sexually transmitted diseases in the world. If left untreated, it can lead to complications such as pelvic inflammatory disease, ectopic pregnancy, stillbirths, severe eye infections in newborn babies, and infertility in both men and women.

In the past two decades, much work has been done to monitor the resistance of gonorrhoea to drugs. Across the Pacific region, 17 laboratories have participated in the World Health Organization’s Gonococcal Antimicrobial Surveillance Program (GASP) established in 1992. Laboratories send data to a coordinating laboratory in Sydney where they are compiled and analysed.[iii]