Nigerians resort to home remedies as threat of untreatable gonorrhoea looms •78m new infections globally — WHO •Antibiotic resistance puts millions at risk of infection •Demand for herbs, fruits, vegetables go up •Panic to prevent “super gonorrhoea” •Ineffective antibiotics being prescribed By Sola Ogundipe, Chioma Obinna & Gabriel Olawale Gonorrhoea, the world’s most commonly reported Sexually Transmitted Infection, STI, is becoming almost untreatable and the reality of incurable gonorrhoea looms. Home remedies for gonorrhea. In recent times, several cases of gonorrhoea have defied treatment following emergence of multi-drug resistance in Neisseria gonorrhoeae (bacteria that causes gonorrhoea) to normal and special strength antibiotics. This was evident last week, when the World Health Organisation, WHO, raised alarm that gonorrhoea has become almost impossible to treat as a result of antibiotic resistance. WHO says each year; an estimated 78 million people are infected with gonorrhoea that infects the genitals, rectum, and throat. Complications of gonorrhoea disproportionally affect women, including pelvic inflammatory disease, ectopic pregnancy and infertility, as well as an increased risk of HIV also in men. The world health body , however, identified lack of public awareness, training of health workers & stigma around sexually transmitted infections as barriers to effective prevention of gonorrhoea. In a statement, Dr TeodoraWi, Medical Officer, Human Reproduction, at WHO, stated: “The bacteria that cause gonorrhoea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them. The widespread resistance to older and cheaper antibiotics has been a source of worry for decades. Raising the alarm that only three new candidate drugs in various stages of clinical development are available, it noted that any new treatment for gonorrhoea should be accessible to everyone who needs it, ensuring it’s used appropriately, to slow drug resistance. “The Research & Development pipeline for gonorrhoea is relatively empty. Every time we use a new class of antibiotics to treat gonorrhoea, the bacteria evolve to resist them. Some countries are finding cases of gonorrhoea that are untreatable by all known antibiotics. This can be prevented through safer sexual behaviour, in particular consistent & correct condom use. “To control gonorrhoea we need new antibiotics, rapid, accurate, point-of-care diagnostic tests. In the long term, there will be a vaccine to prevent it Unfortunately, there are no affordable, rapid, point-of-care diagnostic tests for gonorrhoea. Many people who are infected do not have any symptoms. Untreatable gonorrhoea For most people, the announcement only confirms fears that have been trending for a while, that gonorrhoea is fast becoming untreatable. Findings by Good Health Weekly reveal that common antibiotics like azithromycin, gemifloxacin, ampicillin, gentamicyn and some of the common antibiotics are still being prescribed as treatment despite the emergence of resistant strains. Prior to the latest announcement, the WHO and the Centres for Diseases Control, CDC, issued numerous alerts about the existence of untreatable strains of gonorrhoea on the loose. They warned that the rapid emergence of antimicrobial resistance of the bacteria causing gonorrhoea to all known antibiotics is threatening the world’s ability to cure the disorder. Commonly known as Veneral Disease, VD, “gentleman’s disease”, the “clap”, or the “drip”, gonorrhoea is a contagious disease transmitted most often through sexual contact with an infected person. It may also be spread by contact with infected bodily fluids, and a mother could pass on the infection to her newborn during childbirth. Studies show that gonorrhoea has a long history of evading treatment. It has defied response to some of the most important antibiotics known. History of resistance: The alarm that gonorrhoea is becoming incurable rekindles memories of the 1920s, long before the first drugs to treat it were discovered. Since the 1930s, several classes of antibiotics have been used to fight gonorrhoea, but widespread use – and misuse – of these drugs, has led to rise of antibiotic-resistant strains of the bacteria. In the 1940s, gonorrhoea became resistant to sulfanilamide; in the 1980s, it became resistant to penicillin, tetracycline, chloramphenicol, erythromycin, and streptomycin. By 2007, gonorrhoea was resistant to fluoroquinolones – one of the most powerful group of antibiotics that includes ciprofloxacin, a commonly prescribed antibiotics. New guidelines: In 2013, the WHO introduced the concept of multi-drug combination therapy such as injectable gentamicin and oral azithromycin as effective therapy. Then in 2016, the global health body approved new set of antibiotics for treating gonorrhoea as part of measures to avert development of what is described as “super gonorrhoea”, that is highly resistant to treatment. The new recommendation was for the switch to the cephalosporins – a different family of antibiotics reputed to be resistant-proof, and also expected to bring uniformity to global guidelines. But a new publication in PLoS Medicine indicated robust resistance to three common types of antibiotics prescribed for gonorrhoea is making the rounds. Raising the alarm, Director of Antimicrobial Resistance at WHO, Dr Marc Sprenger stated: “To control gonorrhoea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance and treatment failures. “Specifically, we need new antibiotics, as well as rapid, accurate, point-of-care diagnostic tests – ideally, ones that can predict which antibiotics will work on particular infection – and longer term, a vaccine to prevent gonorrhoea.” The Chief of Urology and Head, Department of Surgery, Lagos University Teaching Hospital, LUTH, Idi Araba, Lagos, Dr. Habeeb Tajani said, “Most times, what people call gonorrhoea isn’t gonorrhoea, but once we are sure it is gonorrhoea, the treatment is antibiotics only. You must be sure that it is gonorrhoea.” He warned that one of the major reasons for so many complications was as a result of poor treatment of gonorrhoea and urged people with suspected cases to consult the doctor in order to have the right diagnosis made. But in the face of failing antibiotic treatment, more Nigerians are looking up to traditional and natural medicine for relief. Herbal medicine: Investigations reveal that traditional treatment of gonorrhoea is fast gaining popularity. Abdulfatai Yakubu, the proprietor of one of such places in Lagos, Aladuba Herbal Medicine, explained that there are ways of using herbs to diagnose and treat the disorder even without carrying out a test. “Gonorrhoea existed before Western medicine and we have always had our traditional way of treating it effectively. “Treating gonorrhoea in the herbal home involves combination of herbs prepared with water and roots in form of powder. The powder can be taken with pap or warm water. The mixture is taken morning and night, and in a few days there must be some level of relief. There are people who after treatment require some herbs to take occasionally for prevention.” Home remedies: Home remedies such as garlic, zinc, vitamin C, vitamin K, amino acids, apple cider vinegar, tea tree oil, yogurt, Aloe Vera, mangosteen and echinacea has become order of day. “The natural approach is best,” a natural medicine practitioner declared. “Many effective natural, homeopathic, dietary and behavioural remedies exist and the beauty of it is that the risk of resistance is much lower than for orthodox medicines. “Diet and lifestyle are perhaps the most effective ways of controlling illnesses and gonorrhoea is no exception.” One development is that more persons are opting for healthy foods including dark chocolate, oysters and sesame seeds that contain special elements like zinc – an essential mineral that boosts the immune system by increasing antibodies and white blood cells which fight bacteria. Appeal for well-known home remedies for dozens of ailments and its value for gonorrhoea treatment have increased. For instance, the desire for garlic, garlic extract and garlic supplements has waxed so strong it is becoming commonplace to find garlic-based dishes on the menu of growing number of homes. Nutritionists say this development is not unusual because garlic possesses powerful antibacterial and antimicrobial properties. The most active ingredient in garlic known as allicin, gives it the characteristically strong anti-inflammatory properties that make it a potential . Also widely acknowledged is the effectiveness of vitamin C, an antioxidant that reduces inflammation in boosting the immune system and increasing resistance to bacterial infections. It does not come as a surprise that consumption of fruits particularly the citrus family such as oranges, grapes, tangerines, etc.,as well as green, leafy vegetables has increased dramatically. 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