In July of last year, the World Health Organization (WHO) raised warnings about the increasing prevalence of multi-drug resistant gonorrhea in a number of countries in Asia and Europe, as well as in Canada. According to the WHO, low coverage of testing and treatment of sexually transmitted infections (STIs) during the COVID-19 pandemic resulted in a surge in STI cases globally, although rates of gonorrhea have been on the rise for much longer than that. In Canada, rates of gonorrhea more than doubled between 2012 and 2021[1]. However, most reports of multi-drug resistant gonorrhea come from high-income countries, and STI screening and data collection from mid- to low-income countries is lacking, which suggests that the prevalence of resistant strains globally is much higher than currently reported[2].
Critical in the fight against multi-drug resistant gonorrhea – and STIs in general – is the deployment of testing that is affordable, effective, and simple to use. Screening helps ensure patients are treated quickly and appropriately and that population trends are reported correctly, especially as WHO strives to reach the targets set out by the Global Health Sector Strategy on HIV, Hepatitis, and STIs. Those targets include a 90% reduction of gonorrhea cases in people aged 15 to 49 from 2020 to 2030[3].
Prior to the 2023 STI & HIV World Congress, the WHO updated its Laboratory and Point-of-Care Diagnostic Testing Guidelines for STIs including HIV with updated information about the detection and diagnosis of STIs as well as information about the use of molecular testing, accessible point-of-care (POC) tests, and a new chapter about quality management of diagnostic tests. The guidelines recommend labs and POC sites be accredited to a national or international standard, such as ISO15189:2022[4].
Ensuring the quality of diagnostic results is of high importance and essential for the accuracy of results. The need of POCT sites to participate in External Quality Assessment programs has been demonstrated before[5].
In addition to revising their diagnostic guidelines for STIs, the WHO also released target product profiles (TPPs) for new point-of-care rapid tests for gonorrhea, chlamydia, trichomoniasis, and syphilis. These tests must be “inexpensive, easy to perform, acceptable to people, reliable, and valid.[6]” Access to high quality point-of-care testing, according to WHO, is critical to improving treatment and reducing the risk of increased antimicrobial resistance:
“The need to advance the development of point-of-care tests for sexually transmitted infections has been recognized, since these will substantially improve the management of sexually transmitted infection cases. Point-of-care testing will potentially reduce the overuse and misuse of antibiotics and could thus decrease the selection pressure for the development of antimicrobial resistance among sexually transmitted pathogens and bystander commensal or pathogenic bacterial species. Point-of-care tests can lower health-care costs, reduce waiting times, speed up and increase the accuracy of treatment and improve patient follow-up.[7]
While much of the funding and effort in combatting illness – and especially antimicrobial resistance – is focused on new medications and vaccinations, diagnostics are equally important to ensuring global access to healthcare.
[1] Chlamydia, gonorrhea and infectious syphilis in Canada: 2021 surveillance data update. Canada.ca. Published October, 2023. Accessed January 12, 2024. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/chlamydia-gonorrhea-infectious-syphilis-2021-surveillance-data.html
[2] Multi-drug resistant gonorrhoea. WHO.int. Published July 11, 2023. Accessed January 12, 2024. https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea
[3] Ibid.
[4] Unemo M, Cole M, Lewis D, Ndowa F, Van Der Pol B, Wi T, editors. Laboratory and point-of-care
diagnostic testing for sexually transmitted infections, including HIV. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. https://iris.who.int/bitstream/handle/10665/374252/9789240077089-eng.pdf?sequence=1
[5] Restelli V, Vimalanathan S, Sreya M, Noble MA, Perrone LA. Ensuring diagnostic testing accuracy for patient care and public health- COVID-19 testing scale-up from an EQA provider’s perspective. PLOS Glob Public Health. 2023 Dec 6;3(12):e0001615. doi: 10.1371/journal.pgph.0001615. PMID: 38055697; PMCID: PMC10699598.
[6] Ibid.
[7] Point-of-care tests for sexually transmitted infections: target product profiles. Geneva: World
Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. https://iris.who.int/bitstream/handle/10665/371294/9789240077102-eng.pdf?sequence=1
