Sexual and reproductive health

WHO launches new treatment guidelines for chlamydia, gonorrhoea and syphilis

Image of the three new guidelines

Recommendations updated to address growing antibiotic resistance

30 August 2016: More than 1 million sexually transmitted infections (STIs) are acquired every day worldwide. STIs present a major burden of disease and negatively affect people’s well-being across the globe. Chlamydia, gonorrhoea and syphilis are three STIs which are all caused by bacteria and which can potentially be cured by antibiotics. Unfortunately, these STIs often go undiagnosed and due to antibiotic resistance, they are also becoming increasingly difficult to treat.

WHO has today launched new treatment guidelines to help address this issue. Based on the latest available evidence, the guidelines share new recommendations on the most effective treatments for these curable sexually transmitted infections.

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tonko43 / CC BY

“Chlamydia, gonorrhoea and syphilis are major public health problems worldwide, affecting millions of peoples’ quality of life, causing serious illness and sometimes death. The new WHO guidelines reinforce the need to treat these STIs with the right antibiotic, at the right dose, and the right time to reduce their spread and improve sexual and reproductive health. To do that, national health services need to monitor the patterns of antibiotic resistance in these infections within their countries.”

Ian Askew, Director, WHO Department of Reproductive Health and Research including HRP.

Sexually transmitted infections (STIs)

STIs can damage well-being

It is estimated that, each year, 131 million people are infected with chlamydia, 78 million with gonorrhoea, and 5.6 million with syphilis. Infection with STIs can have a significant and negative impact upon a person’s overall health and well-being. People infected with an STI may be at risk of stigma and abuse, in addition to further psycho-social consequences, such as a negative effect upon personal relationships.

In addition, when left undiagnosed and untreated, curable STIs can result in serious complications and long-term health problems. For women this can include pelvic inflammatory disease, ectopic pregnancy and miscarriage. Untreated gonorrhoea and chlamydia can cause infertility in both men and women. If a woman has an untreated STI while pregnant, this can infect the baby, and may result in stillbirth or newborn death. Infection with chlamydia, gonorrhoea and syphilis can also increase a person’s risk of being infected with HIV by two to three times.


Gonorrhoea is a common STI that can cause infection in the genitals, rectum, and throat. Antimicrobial resistance has appeared and expanded with every release of new classes of antibiotics for the treatment of gonorrhoea. Because of widespread resistance, older and cheaper antibiotics have lost their effectiveness in treatment of the infection.

WHO urges countries to update their national gonorrhoea treatment guidelines in response to the growing threat of antibiotic resistance. National health authorities should track the prevalence of resistance to different antibiotics in the strains of gonorrhoea circulating among their population. The new guideline calls on health authorities to advise doctors to prescribe whichever antibiotic would be most effective, based on local resistance patterns. The new WHO guidelines do not recommend quinolones (a class of antibiotic drug) for the treatment of gonorrhoea due to widespread high levels of resistance.


Syphilis is spread by contact with a sore on the genitals, anus, rectum, lips or mouth, or from mother to child during pregnancy. If a pregnant woman has untreated syphilis and the infection is transmitted to the fetus, this usually causes it to die. In 2012, mother-to-child transmission of syphilis resulted in an estimated 143 000 early fetal deaths/stillbirths, 62 000 neonatal deaths, 44 000 babies being born preterm/low-birth-weight and 102 000 infected infants.

To cure syphilis, the new WHO guideline strongly recommends a single dose of benzathine penicillin—a form of the antibiotic that is injected by a doctor or nurse into the infected patient’s buttock or thigh muscle. This is the most effective treatment for syphilis; more effective and cheaper than oral antibiotics.

Benzathine penicillin was recognized by the 69th World Health Assembly in May 2016 as an essential medicine which has been in short supply for several years. Reports of stock outs have been received by WHO from antenatal care representatives and providers in countries with high burdens of syphilis from three WHO regions. WHO is working with partners to identify countries with shortages and help monitor global availability of benzathine penicillin to close the gap between global demand and national needs for the antibiotic.


Chlamydia is the most common bacterial STI and people with this infection are frequently co-infected with gonorrhoea. Symptoms of chlamydia include discharge and a burning feeling when urinating, but most people who are infected have no symptoms. Even when chlamydia is asymptomatic, it can damage the reproductive system.

WHO is calling on countries to start using the updated guidelines immediately, as recommended in the Global Health Sector Strategy for STIs (2016-2021) endorsed by governments at the World Health Assembly in May 2016. The new guidelines are also in line with the Global Action Plan on Antimicrobial Resistance, adopted by governments at the World Health Assembly in May 2015.

When used correctly and consistently, condoms are one of the most effective methods of protection against STIs.

Genital Herpes Simplex Virus

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