Piece by: JOHN MUCHANGI

13 January 2023

• Gonorrhoea affects men and women, and is typically spread by oral, anal or vaginal sex. Infections rarely produce noticeable symptoms.

• Cases of drug-resistant gonorrhoea have been reported in Kenya before, but not of this magnitude.

A strand of gonorrhoea resistant to most drugs used to treat the disease is now in Nairobi.

The finding, described by experts as “of concern”, means that many Kenyans are carrying an almost incurable infection that can cause significant health problems, including permanent damage to the reproductive system.

The drug-resistant gonorrhoea was isolated from a sample taken from one of 24 sick sex workers from Nairobi last year.

Amina Abdullahi, a researcher from the Kenya Medical Research Institute (Kemri) who made the discovery, said most of the sick women did not even have the clinical symptoms of gonorrhoea.

She tested the isolated bacterium against 13 antimicrobials which comprise the mainstay antibiotics for the disease in Kenya.

“The result showed complete (100 per cent) resistance to all the antimicrobials,” she reported.

The drugs that failed included ciprofloxacin and ceftriaxone, which are in the current STI treatment algorithm in Kenya.

“The finding from the present study shows possible multidrug-resistant gonorrhoea circulating among female sex workers in Nairobi, which is of concern,” she said.

Gonorrhoea affects both men and women and is typically spread through oral, anal or vaginal sex. Infections rarely produce noticeable symptoms.

However, symptoms may include discharge, burning during urination, unusual sores or rash.

The World Health Organization says gonorrhoea is the second-most common sexually transmitted infection worldwide after chlamydia.

The WHO blames the resistance on overuse of antibiotics, poor-quality drugs and genetic mutations of the bacteria.

“The emergence of different forms of resistance in gonorrhoea is often followed by a rapid spread of the disease,” said Dr Teodora Wi, WHO Medical Officer specialising in STIs.

“The effect is felt in all countries, but with disproportional effects in low- and middle-income countries, where health systems may be underdeveloped or lacking resources,” Teodora added.

Abdullahi, who published her findings in the Plos One journal last year, said many sex workers taking pre-exposure prophylaxis (Prep) to protect against HIV leave themselves vulnerable to other STIs.

“The main driver for engaging in risky sexual behaviours among individuals is the use of Prep.

"Some people have the perception it will not only protect them from HIV but also from STDs, and alcohol consumption, which can inhibit a person’s judgement on the use of protective methods such as condoms,” she said.

Her paper is titled “Neisseria gonorrhoeae infection in female sex workers in an STI clinic in Nairobi, Kenya.”

Cases of drug-resistant gonorrhoea have been reported in Kenya before.

A four-year study by the Nairobi-based NGO Support Widows And Orphans Programme (Swop) reported gonorrhoea resistance to Ciprofloxacin drug had increased over the years.

However, contrary to the present study findings, they found 100 per cent susceptibility to Cefixime, Ceftriaxone, and Spectinomycin.

The Kenya National Guidelines for Prevention, Management, and Control of STIs has no information on the prevalence of gonorrhoea in the country.

In June 2021, the National Aids and STIs Control Programme, a division within the Ministry of Health, said gonorrhoea and chlamydia are spreading rapidly among high school and college-age youth.

“In the last two years, researchers have noted an increase in chlamydia and gonorrhoea among adolescents and young people aged 15 to 24 years up to 29 per cent,” the then Nascop director Dr Catherine Ngugi said.

Chlamydia can fester quietly for months or even years in women before it is detected. By then, the damage has already been done.

“I’m concerned about rising cases of infertility in the future because chlamydia is a silent infection and most infected people are asymptomatic,” Dr Ngugi said.

She spoke at the 6th Maisha HIV and Aids Conference, organised by the National Aids Control Council, in Nairobi.

The two infections are curable but, if untreated, can lead to infertility, neurological and cardiovascular disease, stillbirths, ectopic pregnancy and increased risk of HIV.

The national infertility prevalence in Kenya is estimated to be around 11.9 per cent, with Western and Coast provinces having the highest rates.

In Sub-Saharan Africa, infertility is caused by STIs in more than 85 per cent of women compared to 33 per cent worldwide, according to the World Health Organization.

“We now need to screen for other STIs during HIV testing,” Dr Ngugi said.

In 2017, Dr Simon Masha, a lecturer and researcher based at Pwani University, Kilifi, also published findings of a study carried out among women at an antenatal clinic at the Kilifi County Hospital.

The findings showed 20.8 per cent of the women had a curable STI. Prevalence of chlamydia was 14.9 per cent, gonorrhoea one per cent and bacterial vaginitis at 19.3 per cent.

"Our findings reinforce the need to integrate STI services at ANC," Dr Masha said.