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Gonorrhea No Longer Treatable

Gonorrhea is a sexually transmitted disease (STD) that infects an estimated 820,000 people in the U.S. annually, mostly those between the ages of 15 and 24.1 Worldwide, 78 million people are infected with gonorrhea every year.2 Caused by the Neisseria gonorrhoeae bacterium, gonorrhea is spread by through sexual contact, as well as from mother to baby during childbirth. This bacterial infection has long been easily treated with antibiotics, but gonorrhea is increasingly becoming resistant to available drug treatments.

As such, it’s now being described as an urgent public health issue. Dr. Teodora Wi, medical officer of human reproduction at the World Health Organization (WHO) said, "The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”3 Antibiotic-resistant gonorrhea first emerged when I was in medical school in the late 1970s.

By the 1980s, the antibiotics penicillin and tetracycline were no longer effective against it. Next, gonorrhea resistant to fluoroquinolone antibiotics emerged, leaving only one class of antibiotic drugs, cephalosporins, left to treat it. Now, as you might suspect, gonorrhea is fast becoming resistant to cephalosporins — the last available antibiotics to treat it.

First Strain of Super-Resistant Gonorrhea Reported

In 2013, the U.S. Centers for Disease Control and Prevention (CDC) estimated that about one-third of gonorrhea cases were resistant to at least one antibiotic. They updated treatment guidelines at that time to include a dose of the antibiotic ceftriaxone along with a second antibiotic. As of 2018, the CDC still recommends this dual therapy to treat gonorrhea, specifically a single 250-milligram (mg) dose of intramuscular ceftriaxone and 1 gram (g) of oral azithromycin.4

The two-pronged treatment initially appeared to be working, pushing resistance rates from 1.4 percent in 2011 to 0.4 percent in 2013. However, according to CDC data published in JAMA, “improvements in susceptibility may be short-lived.”5,6 According to the CDC:7

“Gonorrhea has developed resistance to nearly all of the antibiotics used for its treatment. We are currently down to one last recommended and effective class of antibiotics, cephalosporins, to treat this common infection. This is an urgent public health threat because gonorrhea control in the United States largely relies on our ability to successfully treat the infection.”

In the U.K., meanwhile, the first case of gonorrhea that’s resistant to both ceftriaxone and azithromycin has been reported.8 The man was diagnosed in early 2018, and it’s believed he contracted the infection via sexual activity with a person in Southeast Asia about a month prior.

Gwenda Hughes, consultant scientist and head of the sexually transmitted infection section at Public Health England (PHE), said in a statement, “[The infection] … is very resistant to the recommended first-line treatment … This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.”9

The patient is now being treated with an intravenous antibiotic called ertapenem, which is related to ceftriaxone. The infection appears to be responding to the new treatment but officials are planning to retest the patient in April to determine if it was successful. “We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” Hughes said.10

What Are the Health Risks of Gonorrhea?

Although gonorrhea often causes no symptoms, it can lead to a burning or painful sensation when urinating, white, green or yellow discharge from the penis, increased vaginal discharge, painful or swollen testicles in men and vaginal bleeding between periods in women. Rectal infections with gonorrhea may lead to anal discharge, itching, soreness and bleeding or painful bowel movements.

If left untreated (or if the disease progresses because it’s resistant to treatment), gonorrhea can lead to pelvic inflammatory disease (PID) in women, which can cause:

• Scar tissue to form in the fallopian tubes

• Ectopic pregnancy

• Infertility

• Long-term pelvic and abdominal pain

In men, gonorrhea can lead to pain in the tubes attached to the testicles, which can lead to infertility. In addition, if gonorrhea spreads to your blood or joints it can be life-threatening, and it also increases your risk of contracting HIV. If you’re pregnant and you pass gonorrhea to your baby during childbirth, it can lead to blindness, joint infection or a life-threatening blood infection in the baby.11

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