New strain of largely drug-resistant gonorrhea emerges in Austria


New strain of largely drug-resistant gonorrhea emerges in Austria

An illustration of Neisseria gonorrhoeae.

A picture of Neisseria gonorrhoeae.
illustration: Shutterstock (Shutterstock)

That Increase in super gonorrhea continues unabated. Scientists in Europe say they have recently discovered a new strain of largely drug-resistant gonorrhea – the second such strain found worldwide in recent years. The bacterium was detected in April in a man from Austria who probably caught it on a trip to Cambodia.

Neisseria gonorrhoeaethe eponymous cause of gonorrhea, is a particularly robust bacterium. Over the decades, it has learned to beat almost every single antibiotic that has ever been 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.

2018 Doctors discovered Three cases of gonorrhea in the UK and New Zealand caused by a strain simultaneously resistant to both drugs. The cases have been traced to travel in Southeast Asia, and in at least one case available treatments have failed to clear the infection.

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

The case concerned a man who visited an Austrian urology department in April 2022 after experiencing painful urination and urethral discharge, common symptoms of gonorrhea. Five days earlier, on a visit to Cambodia, he had intercourse with a sex worker without using a condom. The man was given ceftriaxone and azithromycin and two weeks later his symptoms appeared to improve. However, laboratory tests showed that he carried a strain with some resistance to ceftriaxone and a high level of resistance to azithromycin, and he remained positive for infection after treatment. He was given a second dose of a different antibiotic and a week later tested negative for viable bacteria. Unfortunately, they could not perform a second PCR test to better confirm the success of the treatment.

Doctors were unable to contact the sex worker, who may also have been infected, but they were able to examine the strain genetically up close. They found that the new strain is very similar to the 2018 strain, suggesting both are from the same lineage linked to Asia, although they don’t 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’s authors note. These infections may be isolated events for now, but if this or a similar strain ever becomes widespread, “many cases of gonorrhea could become incurable,” they warn. While many people infected with gonorrhea may not experience any symptoms, it can lead to life-threatening illness and pregnancy complications, including stillbirth and neonatal blindness, if left untreated.

One bright spot is that this strain was still susceptible to the experimental antibiotics lefamulin and zoliflodacin, which are now being tested in late-stage clinical trials for gonorrhea. Researchers are also working on it vaccinations for gonorrhea. But for now, these options are not a reality, and it will take more success with the tools at our disposal to prevent the germ from becoming an untreatable nightmare.

“Improved prevention (including use of condoms), early and accurate diagnosis, and effective, affordable, and accessible treatment (ideally including cure testing and contact notification and treatment) of gonorrhea are essential,” the authors wrote. “Increased 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 paramount importance.”

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