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Antibiotic resistance — when bacteria evolve to the point that antibiotics are no longer effective against them — has been a longtime concern for health officials. In the last few years, the phenomenon has spilled over into pop culture as well, via some amusing (or frightening, depending on your perspective) headlines about drug-resistant gonorrhea, a.k.a. “super-resistant gonorrhea” or “super gonorrhea” — a strain of the sexually transmitted infection (STI) that could turn out to be untreatable.
What is gonorrhea?
Gonorrhea is an STI caused by the Neisseria gonorrhoeae bacterium. It spreads through vaginal, anal, and oral sex and can infect the penis, vagina, throat, rectum, and eyes. Genital infections are most frequently seen, but oral gonorrhea is also common.
Gonorrhea might produce no symptoms, but it can also cause painful urination, a pus-like discharge, or pain or swelling in one or both testicles. Oral gonorrhea may also be asymptomatic, or it could cause a sore throat. Left untreated, gonorrhea can cause a testicular infection in men or pelvic inflammatory disease (PID) in women. In rare cases, it can spread to the blood and joints.
According to the Centers for Disease Control and Prevention, untreated gonorrhea can cause serious health problems and can increase a person’s risk of acquiring or transmitting HIV.
Gonorrhea is the second most common notifiable disease in the United States: About 3 million cases of gonorrhea are diagnosed in the United States, and 78 million worldwide, each year.
What is the treatment for gonorrhea?
The first-line treatment for gonorrhea is two antibiotics — ceftriaxone, which is administered as an injection in a doctor’s office, then either azithromycin or doxycycline, a prescription taken orally.
What is super-resistant gonorrhea?
Health officials have been dealing with drug-resistant gonorrhea for decades. But super-resistant gonorrhea (nicknamed “super gonorrhea” in some news reports) is gonorrhea that shows resistance to the current first-line antibiotic regimen of ceftriaxone and azithromycin/doxycycline.
In March 2018, Great Britain’s public health agency described a case of a man whose gonorrhea was resistant to ceftriaxone and azithromycin/doxycycline. Health officials expressed concern because backup therapies aren’t readily available. If super-resistant gonorrhea were to spread, that would mean it was essentially untreatable on a large scale.
The British man’s case was ultimately cured with three days of the intravenous (IV) antibiotic ertapenem, a “last-resort” antibiotic normally reserved for severe, life-threatening infections. “If this was to become the norm, the impact on healthcare services would be huge,” Mark Lawton, MD, of the British Association for Sexual Health and HIV, told the Center for Infectious Disease Research and Policy (Dall, 2018).
Soon after the British case was reported, two more cases of super-resistant gonorrhea were reported in Australia.
“It’s not a matter of if gonorrhea will become resistant to the currently recommended antibiotic treatment, but when,” said the CIDRP.
While drug resistance is clearly a concern for health officials, to date, the CDC hasn’t identified any cases of unsuccessful gonorrhea treatment in the United States (CDC, 2019).
Gonorrhea (“the clap”): causes, symptoms, and treatments
How long has gonorrhea been resistant to antibiotics?
Antibiotic-resistant gonorrhea is one of medical science’s wiliest foes, evolving to quickly elude a long line of drugs that were meant to wipe it out. According to the Center for Infectious Disease and Policy (CIDRAP), gonorrhea was first treated with sulfonamide antibiotics starting in 1935, but resistance developed within two years (Dall, 2018). Penicillin was tried next, with resistance reported in the mid-1940s. Ultimately penicillin became ineffective against gonorrhea and was dropped as standard therapy. So were several other drugs that followed: tetracycline, spectinomycin, fluoroquinolones, macrolides, and cephalosporins.
A new antibiotic, zoliflodacin, has shown promise in treating gonorrhea, but it is still in clinical trials (and has been since at least 2015), and no release date has been set (Global, 2019; Maxmen, 2017).
How do you prevent super-resistant gonorrhea?
As the CDC notes, the only way to absolutely avoid STIs is to not have vaginal, anal, or oral sex. The best way to prevent gonorrhea is to use a condom during sexual activity or to be monogamous with a partner who has tested negative for gonorrhea and gets regular STI screenings. Get regular STI screenings yourself — every three months is a good benchmark if you’re sexually active. And see a doctor if you have any symptoms of gonorrhea, so you don’t pass the infection on to your partner.
If you are diagnosed with gonorrhea, take all medication as directed. Inform all of your sexual partners in the last 60 days that they should be tested. And be retested for gonorrhea in three months to ensure you’re no longer infected.
- Centers for Disease Control and Prevention (CDC). (2019). Health Alert Template for Gonorrhea with Reduced Susceptibility. Retrieved February 2, 2020 from https://www.cdc.gov/std/program/outbreakresources/HANtemplate-gono.htm
- Dall, C. (2018). Experts brace for more super-resistant gonorrhea. Retrieved February 2, 2020 from https://www.cidrap.umn.edu/news-perspective/2018/09/experts-brace-more-super-resistant-gonorrhea
- Global Antibiotics Research and Development Partnership. (2019). Zoliflodacin in Uncomplicated Gonorrhoea – Full Text View. Retrieved February 2, 2020 from https://clinicaltrials.gov/ct2/show/NCT03959527
- Maxmen, A. (2017). Untreatable gonorrhoea on the rise worldwide. Nature. Retrieved from https://www.nature.com/articles/nature.2017.22270
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.