New strain of extensively drug-resistant gonorrhea appears in Austria

An illustration of Neisseria gonorrhoeae.

an illustration of Neisseria gonorrhoeae
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The emergence of super gonorrhea continues unabated. Scientists in Europe say they recently discovered a new strain of extensively drug-resistant gonorrhea — the second species found worldwide in recent years. The bacterium was discovered in April in a man from Austria, who probably contracted it while traveling in Cambodia.

Neisseria gonorrhoeaethe namesake cause of gonorrhea, is a particularly hardy bacterium. Over the decades, it has learned how to beat almost any antibiotic ever thrown at 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 discovers three cases of gonorrhea in the UK and New Zealand caused by a strain that was simultaneously resistant to both drugs. The cases were traced to travel in Southeast Asia, and in at least one case, the infection could not be cleared by available treatments.

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

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

The doctors were unable to contact the possibly infected sex worker, but were able to study the species genetically up close. They found that the new species is very similar to the 2018 species, indicating that both are of the same lineage linked to Asia, 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, the report authors note. These infections may be isolated events for now, but if this or a similar strain ever spreads widely, “many cases of gonorrhea could become untreatable,” they warn. While many people infected with gonorrhea may not experience any symptoms, it can cause life-threatening illnesses and pregnancy complications, including stillbirths and newborn blindness, if left untreated.

On the bright side, this strain was still susceptible to the experimental antibiotics lefamulin and zoliflodacin, which are now being tested in late clinical trials for gonorrhea. Researchers are also working on vaccines for gonorrhea. But for now, these options are still not a reality, and it will take more success with the tools we have available to keep the germ from turning into an untreatable nightmare.

“Improved prevention (including condom use), early and accurate diagnosis, and effective, affordable and accessible treatment (ideally including testing of cure and contact reporting and treatment) of gonorrhea are imperative,” the authors wrote. “Enhanced surveillance of antimicrobial resistance, 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 utmost importance.”

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