Antimicrobial Resistance in STIs

Antimicrobials are meant to treat various infections caused by microorganisms like bacteria, viruses, fungi, and parasites. Recently, antimicrobial resistance (AMR) has become a silent pandemic.

In particular, antimicrobial resistance in sexually transmitted infections (STIs) is compromising the management and control of the various types of STIs. People with STIs may experience serious health complications — such as neurological and cardiovascular disease — if left untreated. 

This health threat is straining health systems globally, and it’s growing. However, quality antimicrobial resistance testing, research, and diagnostics can make a difference in promoting antimicrobial stewardship. 

Understanding Antimicrobial Resistance in Sexually Transmitted Infections

Although antimicrobials help prevent the spread of various types of infections and diseases, these microbes have begun to develop resistance to the drugs designed to eliminate them.

The stronger microorganisms become, it grows increasingly challenging to manage the infections they cause. Over time, a medication can decline in its effectiveness and lead to the emergence of “superbugs,” which are a threat to public health outcomes. For instance, AMR is responsible for 2.8 million infections annually in the United States alone — with health costs reaching over $4.6 billion. 

Antimicrobial vs. Antibiotic Resistance

Note the difference between antimicrobial vs. antibiotic resistance. When discussing antimicrobial resistance, the topic also includes antibiotic resistance. Where antibiotic resistance only refers to drug-resistant bacteria, antimicrobial resistance encompasses a wide group of medications used to intervene and prevent bacterial, parasitical, viral, and fungal infections. 

Multi-Drug Resistant (MDR) STIs

Looking at antimicrobial resistance in STIs, the topic isn’t new, but the increase of multi-drug resistant strains is. This is especially the case with the bacterium that causes the STI gonorrhea. Antimicrobial resistance in Neisseria gonorrhoeae was first observed in the 1980s, showing resistance to tetracycline and ciprofloxacin. Since then, it has also demonstrated resistance to azithromycin, macrolides, fluoroquinolones, and cephalosporins. This microorganism shows a remarkable ability to resist multiple drugs at a rapid rate. 

Mycoplasma genitalium antibiotic resistance is another cause of concern, as it’s showing similar trends as N. gonorrhoeae. The microbe exhibits high levels of resistance against multiple antibiotics in multiple countries, like the U.S., Europe, Australia, and Japan. 

Development of AMR STIs

The World Health Organization (WHO) states the development of AMR STIs is a result of the following factors: 

• Microbe genetic mutations
• Unrestricted access to antimicrobials
• Improper selection of antibiotics
• Overuse of antibiotics
• Poor quality antibiotics

Although the WHO has set ambitious goals to decrease STIs through the Global Health Sector Strategies (GHSS) 2022-2030, it must address global AMR first. One such strategy involves increasing countries’ reports of AMR in N. gonorrhoeae to the Gonococcal Antimicrobial Surveillance Programme (GASP). 

Why Accurate AMR Testing Matters

AMR in STIs is a global health outcome threat, but it can be combated with accurate and rapid antimicrobial resistance testing. Also known as antimicrobial susceptibility testing (AST), it aids in infection prevention and control (IPC). 

Clinical laboratories use AST to determine which antimicrobial regimen is most effective for individual patients and to help predict therapeutic intervention outcomes provided by health care facilities. Biochemical and phenotypic AST testing methods are typically time-consuming. These methods require 24 hours for a colony to grow and an additional 24 hours for isolate categorization. Using qualitative or quantitative results, the testing method categorizes the bacteria as either susceptible, intermediate, or resistant. Researchers must also implement surveillance activities to identify the bacteria’s resistance patterns. 

Other types of AMR testing methods for STIs include: 

• Culture-based methods like agar dilutions, disc diffusions, and e-tests.
• Molecular methods like nucleic acid amplification tests (NAATs), molecular AMR prediction assays, and point-of-care (POC) tests.

Detecting macrolide-resistant and fluoroquinolone-resistant single nucleotide polymorphisms (SNPs) is critical for guiding effective therapeutic interventions, particularly for M. genitalium, which has shown increasing resistance to both antibiotic classes. 

The Role of Clinical Research in Combating Drug-Resistant STI Outbreaks

Clinical research plays a major role in combating AMR STI outbreaks. We need to better understand these multidrug-resistantSTIs to prevent and control them — doing so will positively impact public health outcomes globally. Given the global scale of this threat, collaboration among diverse organizations is necessary to combat its spread.

The Centers for Disease Control and Prevention (CDC), for instance, has a Combating Antimicrobial Resistant Gonorrhea and Other STIs (CARGOS) project. It aims to monitor AMR trends in STIs throughout the U.S.

Additionally, antimicrobial stewardship (AMS) programs combat AMR through optimized antimicrobial drug use. Although antimicrobials are vital, it’s their overuse or misuse that contributes to AMR. As such, AMS programs aim to reduce any unnecessary and inappropriate antimicrobial prescriptions. AMS must be implemented in all health care system touchpoints — including clinical laboratories. 

In fact, labs are critical to the success of AMS programs in the following ways: 

• Identification and AST for patients: Through diagnostic test results, labs can identify the infectious agent and its AMR. This information facilitates physicians with appropriate drug prescriptions.  
• Surveillance and outbreak investigation reporting: Labs are vital for research as they monitor trends in AMR and share their reports regarding AST with physicians. Their research also aids with outbreak detection and reporting to the applicable regulatory authorities. 
• Education for physicians: Labs’ findings can educate physicians about the various tests and technologies that facilitate AMS. 

Clinical research and laboratories further promote AMS — and diagnostic stewardship (DxS) — through rapid diagnostic testing (RDT). Traditional testing methods are slow, prompting physicians to help patients with broad-spectrum antibiotics without waiting for lab results. However, with RDT, labs can provide fast and accurate results through different techniques, such as: 

• Polymerase chain reaction (PCR)
• Magnetic resonance
• Mass spectrometry
• Microarray technology
• Next-generation sequencing

Modern Challenges in AMR Research and Detection

Antimicrobial resistance in STIs presents challenges in both its research and detection. Improved diagnostic tools, surveillance systems, and therapeutic interventions can combat these challenges as resistance rates continue to rise. The key challenges to address include:

1. Rapid evolving resistance patterns: It’s clear that M. genitalium, N. gonorrhoeae, and other STIs are developing resistance to first-line and second-line therapeutic interventions. The more STIs become multidrug-resistant, the more it complicates therapeutic intervention options. 
2. Limited AMR testing availability: Some diagnostic tools may not always include macrolide- and fluoroquinolone-resistance detection. 
3. Surveillance gaps: Many regions lack systematic AMR monitoring for STIs, which could cause delays in recognizing resistance trends. This could be the case with low- and middle-income countries (LMICs). As such. global coordination from appropriate regulatory bodies is needed to standardize surveillance systems and AMR reporting. 
4. Therapeutic intervention challenges and stewardship: Empiric antibiotic use drives resistance, especially in cases where rapid and accurate testing techniques are required. Additionally, high STI prevalence and weak antimicrobial stewardship add another layer of complexity. Antimicrobial stewardship programs must balance effective treatment with reducing resistance selection pressure. 
5. Lack of novel therapeutic options: There are few new drugs in the pipeline developed to target AMR STIs. However, zoliflodacin is an experimental antibiotic that could become a new option. That said, combination therapies and novel drug classes require further clinical validation.

Why Trust Applied BioCode Inc.

For optimized STI research testing, partner with Applied BioCode Inc. We utilize advanced solutions, such as our BioCode^® STI + Resistance Panel (RUO), to enhance research testing and maintain high quality. This qualitative panel is a multiplex nucleic acid amplification test capable of detecting and identifying nucleic acids simultaneously. 

It can test and identify nucleic acids from:

• N. gonorrhoeae
• M. genitalium
• Chlamydia trachomatis
• Trichomonas vaginalis

It also targets macrolide-resistant and fluoroquinolone-resistant SNP mutations in  M. genitalium and SNPs associated with fluoroquinolone resistance in NG.

Additionally, our solution is designed to utilize our BioCode^® MDx-3000 Instrument — an advanced molecular diagnostic system specifically designed for panel testing. This instrument is designed for high-throughput, multiplex testing, processing up to 96 samples in a single run and running up to three different panels at a time.

Our Barcoded Magnetic Bead (BMB) technology sets us apart. This technology enables labs to test for multiple targets in a single sample, in a single well. 

Optimize Your STI Research Testing With Applied BioCode Inc.

Antimicrobial resistance in STIs is a serious public health outcomes concern that can impact many lives. Laboratories and accurate diagnostics can help reduce its effect using high-quality, efficient research and testing solutions. 

Invest in the BioCode^® STI + Resistance Panel (RUO) to test AMR in various nucleic acids. With this panel, labs can minimize errors and allow simultaneous detection of multiple pathogens and resistance mutations in a single reaction. Our panel enables researchers to better understand macrolide and fluoroquinolone resistance. 

Contact us for more information about the BioCode^® STI + Resistance Panel (RUO) and how it can help optimize your STI research testing.