The Massachusetts Department of Public Health is warning about the presence of a “concerning” and “novel” gonorrhea strain that showed resistance to several types of antibiotics.
State officials identified the strain in two people: One resident had a “reduced response” to five classes of antibiotics that can be used to treat the sexually transmitted infection (STI), while the other had genetic markers that indicate a “similar drug response.” The individuals appear to have no direct connection with one another. Experts believe this is the first time this type of drug-resistant gonorrhea has been detected in the United States, though the strain has been identified in other countries in the past.
The two people who were infected were eventually “cured” with the antibiotic ceftriaxone, the primary treatment for gonorrhea, health officials said in a press release. However, the novel strain had “reduced susceptibility” to ceftriaxone, as well as the antibiotics cefixime and azithromycin, meaning these drugs didn’t work as well as expected at certain doses; the strain was “resistant” to ciprofloxacin, penicillin, and tetracycline, meaning these antibiotics didn’t clear the infection.
“It’s becoming harder and harder to treat gonorrhea,” Amesh A. Adalja, MD, infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security, tells SELF.
In August, the World Health Organization (WHO) warned that antibiotic resistance in gonorrhea has “increased rapidly in recent years.” So what does gonorrhea treatment look like now—and how can you stay safe? Here’s what you should know.
Gonorrhea is common—and symptoms of the STI aren’t always obvious.
A little refresher: Gonorrhea is an STI caused by the Neisseria gonorrhoeae bacteria, according to the Centers for Disease Control and Prevention (CDC). More than 677,000 gonorrhea infections were reported to the CDC in 2020, making it the second most commonly reported STI in the US for that year (chlamydia was the most common). Gonorrhea rates hit a “historic low” in 2009, but have surged by 111% since then; between 2019 and 2020, reported gonorrhea rates increased by nearly 6%.
In 2020, about half of all gonorrhea infections were thought to be resistant to at least one antibiotic, per the CDC. Antibiotic resistance means a strain of bacteria has mutated in a way that allows it to circumvent the drugs designed to destroy it. So, the resistant strain is not killed by the medication and continues to replicate, upping the risk for transmission. This can then lead to more gonorrhea infections that don’t respond to typical treatments.
Many people who have gonorrhea don’t have any symptoms, so the real burden is likely much higher—potentially up to 1.6 million new infections are thought to occur each year, the CDC notes. N. gonorrhoeae can infect anyone who is sexually active; the bacteria tend to take hold in the reproductive tract, which can include the cervix, uterus, fallopian tubes, or urethra. The bacteria can also infect the membranes of the mouth, throat, eyes, and rectum, meaning you can contract gonorrhea by having unprotected vaginal, anal, or oral sex with someone who is infected. (A pregnant person can also pass the infection to their baby during vaginal delivery.)
When symptoms are present, they may vary from person to person, depending on the area that’s infected; gonorrhea symptoms can also be mistaken for other common health issues, like a urinary tract infection. These are the most common signs to be aware of, per the CDC:
- Painful or burning sensation when peeing
- Increased vaginal discharge
- White, yellow, or green discharge from the penis
- Vaginal bleeding between periods
- Painful or swollen testicles
- Anal itching, discharge, soreness/pain, or bleeding
The rise of drug-resistant gonorrhea doesn’t mean there are no treatments available—but the options are limited.
Gonorrhea used to be treated with a class of antibiotics called fluoroquinolones, but is now primarily treated with cephalosporins (which include the aforementioned ceftriaxone). Currently, the primary treatment for gonorrhea is a single, 500-milligram injection of ceftriaxone, and, because reinfection is common, the CDC recommends being retested three months after treatment. So far, ceftriaxone has been an effective cure for the strains of gonorrhea that have been detected in the US, Thomas Russo, MD, a professor and the chief of infectious diseases at the University at Buffalo in New York.
If that initial injection of ceftriaxone doesn’t beat the bacteria, a doctor should prescribe a higher dose, potentially with another “second-line” antibiotic, Dr. Russo says. “This is why culture and susceptibility testing is important,” he explains. “It may identify alternatives.”
However, the CDC warns that if a strain of gonorrhea that’s resistant to cephalosporins eventually emerges, it would “significantly complicate” our ability to treat the STI successfully—there are few antibiotic options left that are “simple, well-studied, well-tolerated, and highly effective” against the bacteria. That doesn’t mean we suddenly have no options, but it does mean that our options are becoming limited. Experts are studying the efficacy of new drugs to treat gonorrhea, but they may take years to reach the market. And quick, effective treatment is pretty crucial: Untreated gonorrhea can potentially lead to serious complications for some people, including pelvic inflammatory disease, an infection of the uterus, fallopian tubes, or ovaries that can raise a person’s risk of infertility, according to Dr. Russo. In rare cases, untreated gonorrhea can also become life-threatening if the infection spreads to your bloodstream or joints.
The best way to avoid any issues that gonorrhea may give you is to try to avoid the STI in the first place—which, of course, is up to both you and your sexual partner(s). This starts with having open, honest communication about sex. Using a barrier method (like a condom, diaphragm, or dental dam) correctly will help reduce your risk of contracting or spreading various STIs (again, you or your partner(s) may not even be aware that you have an infection, so using protection is important even if you don’t have symptoms).
Dr. Adalja also says it’s “critical” for any sexually active person to get tested for STIs regularly to ensure early detection; the CDC recommends at least once a year for gonorrhea, syphilis, and chlamydia, or more frequently—at least every three to six months—if you recently had sex with a new partner or multiple partners. If you’re not totally sure how often you should get tested, don’t hesitate to bring it up with your doctor. (You can find an STI testing site in your area here, or you can visit your local Planned Parenthood for these services.)
If you happen to develop any symptoms that feel out of your norm—pain, discharge, just a general feeling that something is “off”—don’t wait to see your primary care doctor, ob-gyn, or even a provider at your urgent care clinic, Dr. Russo says: “Fast and effective treatment is important.”
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