A new strain of highly drug-resistant gonorrhea appears in Austria

An illustration of Neisseria gonorrhoeae.

An illustration of Neisseria gonorrhoeae.
Drawing: Shutterstock (Shutterstock)

The increase in super gonorrhea continues relentlessly. European scientists claim to have recently discovered a new strain of ultra-drug-resistant gonorrhea, the second of its kind to be discovered worldwide in recent years. The bacteria was detected in April in a man from Austria, who probably caught it while traveling in Cambodia.

Neisseria gonorrhoeaethe homonymous cause of gonorrhea, is a particularly resistant bacterium. Over the decades, he learned to beat almost every antibiotic ever thrown at him. And now we’ve gotten to 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 resistant to both drugs at the same time. The cases were traced to travel in Southeast Asia, and in at least one case the infection was not cleared by available treatments.

Since then, countries have continued to routinely report azithromycin-resistant strains. And some countries, including the United States, have advised that azithromycin should no longer be used as a first-line treatment at all. But many doctors can continue to treat patients with the combination therapy, and there have been signs of increased resistance to ceftriaxone as well. In a case report published last month in the journal Eurosurveillance, doctors appear to have found the first strain of gonorrhea since 2018 to show resistance to both drugs.

The case involved a man who visited an Austrian urology unit in April 2022 after experiencing painful urination and urethral discharge, common symptoms of gonorrhea. Five days earlier, he had had sex with a sex worker while visiting Cambodia, without using a condom. The man was given ceftriaxone and azithromycin, and two weeks later his symptoms seemed to disappear. But lab tests revealed he carried a strain with some ceftriaxone resistance and high azithromycin resistance, and he remained positive for the infection after treatment. He received a second dose of a different antibiotic and a week later tested negative for viable bacteria. Unfortunately, they were unable to perform a second PCR test to better confirm the success of the treatment.

Doctors were unable to make contact with the sex worker who may also be infected, but they were able to study the strain genetically closely. They found that the new strain closely resembles the 2018 strain, indicating that the two belong to the same Asian-related lineage, although they do not appear to be directly related. And both strains also seem to have learned to resist ceftriaxone by acquiring the same mutation.

Extensively drug-resistant gonorrhea is a global public health threat, note the report’s authors. These infections may be isolated events at this time, but if this strain or a similar strain begins to spread widely, then “many cases of gonorrhea could become incurable”, they warn. Although many people infected with gonorrhea have no symptoms, it can lead to life-threatening illness and pregnancy complications, including stillbirths and blindness in newborns, if left untreated.

A silver lining is that this strain was still susceptible to the experimental antibiotics lefamulin and zoliflodacin, which are currently being tested in late-stage clinical trials for gonorrhea. Researchers are also working on vaccines for gonorrhea. But for now, those options are still not a reality, and it will take more success with the tools we have to prevent the germ from becoming an incurable nightmare.

“Better prevention (including condom use), early and accurate diagnosis and effective, affordable and accessible treatment (ideally including cure test and contact notification and treatment) of gonorrhea are imperative,” wrote the authors. “Enhanced antimicrobial resistance surveillance, ideally including cure testing and whole genome sequencing, nationally and internationally, particularly in Asia where many ceftriaxone-resistant strains appear to have emerged, is of the utmost importance.”

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