Super gonorrhea has infected people in the United States for the first known time. This week, Massachusetts public health officials announced the discovery of two gonorrhea cases appearing to display increased resistance to all known antibiotic classes that can be used against it. These cases were thankfully still curable, but it’s the latest reminder that this common sexually transmitted infection is becoming a more serious threat.
Gonorrhea, caused by the namesake bacteria Neisseria gonorrhoeae, is the second most commonly reported STI in the U.S., with 677,769 cases documented in 2020. Many infected people don’t experience illness, but initial symptoms can include a discolored discharge from the genitals, painful or burning urination, and rectal bleeding if caught from anal sex. When gonorrhea is left untreated, it raises the risk of more serious complications, like damage to the reproductive tract in women and swollen testicles in men, both of which can lead to infertility. And when it’s passed down from mother to child, the infection can be fatal or cause blindness in newborns.
While gonorrhea was once easily treatable with a simple pill of penicillin or other antibiotics, the bacteria has steadily learned to resist almost every drug put in its path. These days, only one or two antibiotics taken at the same time (depending on the region) are considered reliably effective against gonorrhea and are recommended as front-line treatments. But in recent years, doctors have seen cases of gonorrhea where it’s started to evade even these drugs. These extensively hardy, or pan-resistant, infections have been documented in parts of Europe and Asia to date, but at least two similar cases have now been identified in Massachusetts.
According to the state health department, the strain of gonorrhea isolated from one case clearly showed resistance or a reduced response to five classes of antibiotics, while the strain pulled from the second case was genetically close enough that it would likely have similar resistance. A common genetic marker seen in these cases was previously identified in a case reported in Nevada, but that strain still responded normally to at least one class of antibiotics. As far as health officials know, these are the first documented gonorrhea cases to show increased resistance to all of the drug classes known to treat it ever identified in the U.S.
“The discovery of this strain of gonorrhea is a serious public health concern which DPH, the CDC, and other health departments have been vigilant about detecting in the US,” said Public Health Commissioner Margret Cooke, in a statement from the agency.
Growing rates of resistance to the antibiotic azithromycin led the U.S. to stop recommending it for gonorrhea in late 2020. Now, only the drug ceftriaxone—taken as an injection—is considered a frontline option in the country, and at a higher dose than before. Luckily, despite the reduced response to ceftriaxone, both cases were successfully cleared after patients took these higher doses.
These cases are likely only a warning of what’s to come. Some of the important genetic markers seen in this novel strain have been spotted in pan-resistant cases from Europe and Asia, which shows that these mutations are continuing to spread around the world. Gonorrhea rates in general have increased year after year in the U.S. And perhaps most worryingly, no clear connection between the two Massachusetts cases has been found, indicating that these strains may already be circulating past the point where they could be easily contained.
There are ongoing efforts to develop vaccines and novel antibiotics against gonorrhea, but it may take years before any of these come to fruition, if any do. So it’s only become more important to take precautions against contracting and spreading these STIs in the first place. Health officials are now alerting doctors and testing labs in Massachusetts to look out for and report any similar cases.
“We urge all sexually active people to be regularly tested for sexually transmitted infections and to consider reducing the number of their sexual partners and increasing their use of condoms when having sex. Clinicians are advised to review the clinical alert and assist with our expanded surveillance efforts,” said Cooke.