Drug-Resistant Gonorrhea: Experts Concerned After Cases Identified - Healthline

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• Massachusetts' Department of Public Health announced that two residents were recently diagnosed with a novel strain of gonorrhea that's less responsive to medications.
• Gonorrhea is the second most common sexually-transmitted infection (STI) in the U.S.
• Cases of STIs, including gonorrhea, surged during the pandemic.

There's a new strain of gonorrhea circulating in the United States that's more resistant to antibiotics.

Massachusetts' Department of Public Health (DPH) announced last week that two residents were recently diagnosed with a novel strain of gonorrhea that's less responsive to the medications commonly used to treat the disease.

A case involving a similar strain was also recently detected in Nevada.

Both cases in Massachusetts were successfully treated with ceftriaxone — the current go-to medication for gonorrhea.

According to the DPH, this is the first time that a gonorrhea strain has appeared resistant to five classes of antibiotics in the United States.

Gonorrhea is the second most common sexually-transmitted infection (STI) in the U.S.

Cases of STIs, including gonorrhea, surged during the pandemic when preventative treatment and care were deprioritized and delayed.

The rise of drug-resistant pathogens poses a significant public threat, says Dr. Jake Scott, a board-certified infectious diseases specialist with Stanford Health Care.

"In order to curb this alarming trend, it is important that sexually-active people who might be at risk for gonorrhea undergo routine testing, adhere to treatment if it is provided to them, inform their sex partners if they test positive, and have repeat testing done if they have ongoing symptoms or if they have gonococcal pharyngitis (throat infection)," Scott told Healthline.

Drug-resistant gonorrhea is becoming more common 

Dr. Priya Shankar, MPH, an assistant professor of pediatrics at the University of California, San Francisco who specializes in reproductive and sexual health, says drug-resistant gonorrhea strains have been evolving ever since antibiotics were first used to treat the disease.

According to Shankar, the increasing resistance can be pegged to a few factors — underusing medications, using incorrect medications, incomplete treatment, and new mutations the bacteria picks up as it evolves.

Healthcare providers often prescribe antibiotics to patients diagnosed with gonorrhea, without knowing how susceptible the strain is to different antibiotics, says Scott.

"The use of partially-effective antibiotics can lead to the development of resistance by way of selective pressure," Scott said.

"Antibiotics are often prescribed when they are not needed, and the overuse of antibiotics is a major driver of antibiotic resistance," Scott added.

New antibiotics — like fluoroquinolones and cefixime — have been developed; however, the bacteria quickly became resistant to them as well, adds Scott.

Given gonorrhea's long history of becoming resistant to drugs, Scott expects that new, drug-resistant strains will continue to emerge — and, unfortunately, new antibiotics are not being developed and authorized fast enough.

How to treat drug-resistant gonorrhea

Because reinfection and recurrent symptoms are common, people who were treated but continue to have symptoms will likely first be retreated with ceftriaxone, says Shankar.

They may also receive a two-times stronger dose of ceftriaxone, says Scott.

If their provider suspects they may have developed a drug-resistant strain, the patient will provide a culture that'll undergo antimicrobial susceptibility testing to help identify which antimicrobial regimen will be most effective.

If the strain is less susceptible to certain medications, patients will receive a combination of gentamicin and azithromycin, according to Shankar.

"In rare cases of high-level ceftriaxone resistance, ertapenem (also a derivative of penicillin) has been shown to be effective," Scott said.

How to prevent gonorrhea

Gonorrhea is transmitted through sexual intercourse, and while many people develop symptoms, including vaginal or penile discharge, pelvic or testicular pain, and rectal soreness or itching, others will develop no symptoms at all.

Asymptomatic cases have contributed to inadequate detection and treatment of cases, Scott says.

Because of this, it's crucial to ensure that all of your sexual partners have been screened and treated for gonorrhea.

"It is important that those who are at risk for sexually transmitted infections undergo regular routine screenings, preferably at all anatomic sites of possible exposure," Scott says.

In addition, condoms are highly effective at preventing the spread of gonorrhea, according to Shankar.

Those who test positive for gonorrhea should abstain from sexual intercourse for one week after completing treatment, Scott advised.

"We recommend that if you are sexually active, you speak with your healthcare provider honestly and openly about your reproductive health and we can find ways to support you," Shankar said.

The bottom line: 

There's a new strain of gonorrhea circulating in the United States that's more resistant to antibiotics. The overuse and misuse of antibiotics has contributed to the rise of drug-resistant strains. Drug-resistant gonorrhea can be treated with a stronger dose of common antibiotics or with a combination of other antibiotics.