Stepping up the prevention, diagnosis and treatment of sexually transmitted infections (STIs) through innovation was the focus of a satellite session hosted by GARDP, together with key partners, at the International Conference on AIDS and STIs in Africa (ICASA) on 6 December 2021.

GARDP, the World Health Organization, Wits RHI and the Foundation for Professional Development brought together a range of experts to discuss challenges and solutions in the prevention, diagnosis and treatment of STIs. The worrying rise in antimicrobial resistance (AMR) which is reducing treatment options for gonorrhoea, was a pivotal issue during the session.

More than one million STIs are acquired every day worldwide. If untreated, they can have serious and permanent consequences for sexual and reproductive health, as well as newborn and child health. They also increase the risk of HIV transmission. This was highlighted by WHO Medical Officer, Teodora Wi, who called for more attention and action on STIs in all spheres.

“We need to re-energize and re-frame the response to STIs after years of neglect,” Wi said. She proposed several ways to shift the trajectory, including increasing access to screening and treatment for STIs, boosting funding and integrating STI services within family planning and HIV services.

Francis Ndowa of the International Union against STIs said it was vital to monitor STIs for AMR.

“We need to implement primary prevention. We need to screen and treat and use presumptive treatment in areas with high frequency transmission. We need to improve effective services, diagnosis and case management and boost partner notification.”

Ranmini Kularatne of South Africa’s National Institute for Communicable Diseases, said studies had shown that two thirds of gonorrhoea infections in South Africa were asymptomatic. This posed challenges.

“We will closely monitor resistance in Neisseria gonorrhoea and in other STI pathogens to determine whether we need to revise STI management guidelines. We are also working on genome sequencing of pathogens to get a better understanding of resistance, as well as transmission dynamics in South Africa.”

Speakers also described innovations in diagnostics and treatment of STIs. Senior Access Manager for GARDP, Fernando Pascual Martinez, outlined GARDP’s partnership with biotech Entasis Therapeutics on the development of novel antibiotic zoliflodacin. As a first-in-class treatment, it is active against resistant strains of gonorrhoea. The drug is currently being evaluated in a phase 3 trial and has been recruiting patients in South Africa, the United States, the Netherlands and Thailand.

Zoliflodacin has shown activity in vitro against resistant gonorrhoea and, during the panel discussion, Dr Wi highlighted that its role in first-line treatment in specific populations should be considered.

There was broad agreement that the strengthening of AMR susceptibility testing and AMR surveillance was essential. This would support decisions on the best use of new drugs and diagnostics. Better surveillance will also help to build better resistance models.

Apart from developing the product, GARDP also wants to take it to the next step – of access – to ensure it gets to the people who need it.

Another potentially game-changing development was outlined by Jeremie Piton of the FIND Diagnostic Alliance, which is developing an affordable point-of-care test for gonorrhoea. It is currently under field evaluation in South Africa.