An illustration of Neisseria gonorrhoeae.Illustration: Shutterstock (Shutterstock)
The rise of super gonorrhea continues unabated. Scientists in Europe say they’ve recently discovered a new strain of extensively drug-resistant gonorrhea — the second such strain to be found worldwide in recent years. The bacteria were detected in April in a man from Austria, who likely caught it while traveling in Cambodia.
Neisseria gonorrhoeaethe namesake cause of gonorrhea, is an especially hardy bacteria. Over the decades, it’s learned how to beat almost every single antibiotic ever thrown against it. And now we’re at the point where only two drugs are recommended to treat these common infections, depending on the region: ceftriaxone and azithromycin.
In 2018, doctors discovered three cases of gonorrhea in the UK and New Zealand caused by a strain that was resistant to both drugs at the same time. The cases were traced back to travel in Southeast Asia, and in at least one case, the infection failed to be cleared by available treatments.
Since then, countries have continued to routinely report strains resistant to azithromycin. And some countries, including the US, have recommended that azithromycin no longer be used as a frontline treatment at all. But many doctors may continue to treat patients with the combination therapy, and there have been signs of increasing ceftriaxone resistance as well. In a case report published last month in the journal Eurosurveillance, doctors appear to have found the first gonorrhea strain since 2018 to feature resistance to both drugs.
The case involved a man who visited an Austrian urology department in April 2022 after experiencing painful urination and urethral discharge, common symptoms of gonorrhea. Five days earlier, he had intercourse with a female sex worker while visiting Cambodia, without using a condom. The man was given ceftriaxone and azithromycin, and two weeks later, his symptoms seemed to clear up. But lab tests revealed that he carried a strain with some resistance to ceftriaxone and high level resistance to azithromycin, and he remained positive for infection after treatment. He was given a second dose of a different antibiotic and a week later did a negative test for viable bacteria. Unfortunately, they weren’t able to run a second PCR test to better confirm the treatment’s success.
The doctors were not able to get in touch with the sex worker who may also be infected, but they were able to study the strain up close genetically. They found that the new strain bears a close resemblance to the 2018 strain, indicating that both are from the same lineage linked to Asia, though they do not seem to be directly related. And both strains also appear to have learned to resist ceftriaxone by acquiring the same mutation.
Extensively drug-resistant gonorrhea is a global public health threat, the report authors note. These infections may be isolated events for the time being, but if this or a similar strain ever starts to spread widely, then “many gonorrhea cases might become untreatable,” they warn. While many people infected with gonorrhea may not experience any symptoms, it can cause life-threatening illness and pregnancy complications, including stillbirths and blindness in newborns, if left untreated.
One silver lining is that this strain was still susceptible to the experimental antibiotics lefamulin and zoliflodacin, which are now being tested in late-stage clinical trials for gonorrhea. Researchers are also working on vaccines for gonorrhea. But for now, these options are still not reality, and it will take more success with the tools we have available to keep the germ from becoming an untreatable nightmare.
“Improved prevention (including condom use), early and accurate diagnosis and effective, affordable and accessible treatment (ideally including test of cure and contact notification and treatment) of gonorrhea are imperative,” the authors wrote. “Enhanced antimicrobial resistance surveillance, ideally including test of cure and whole-genome sequencing, nationally and internationally, particularly in Asia where many ceftriaxone-resistant strains appear to have emerged, is of the highest importance.”