“Super gonorrhea” is a term for strains of the sexually transmitted infection gonorrhea that are highly resistant to the antibiotics used for treatment. This resistance poses a public health challenge globally, as the bacterium Neisseria gonorrhoeae has evolved to render many standard treatments ineffective. This complicates efforts to control the spread of an already common infection.
The Rise of Antibiotic Resistance in Gonorrhea
The emergence of antibiotic-resistant gonorrhea is an example of microbial evolution. Neisseria gonorrhoeae has a strong ability to adapt and develop defenses against drugs. This resistance develops through genetic mutations that alter an antibiotic’s target. The bacterium can also acquire new genetic material from other resistant bacteria through horizontal gene transfer, which can happen in areas like the throat where different bacteria coexist.
This adaptability has led to a historical progression of resistance against successive classes of antibiotics. In the 1940s, sulfonamides were the first line of defense, but resistance soon followed. Penicillin and tetracycline became standard treatments, but by the 1980s, resistance made them largely obsolete. Fluoroquinolones, such as ciprofloxacin, were introduced as a replacement, but by 2007, resistance to this class also became prevalent.
The most recent line of defense has been third-generation cephalosporins, like ceftriaxone. However, strains showing decreased susceptibility to these last-resort antibiotics have been reported in multiple countries. This has led to the term “super gonorrhea,” signifying strains that are extensively drug-resistant, raising concerns about the potential for untreatable gonorrhea.
Symptoms and Associated Health Complications
The symptoms of a gonorrhea infection differ between men and women, and a significant number of infections, especially in women, may be asymptomatic. When symptoms appear in men, they commonly include a painful sensation during urination and a white, yellow, or green discharge from the penis. Testicular pain or swelling can also occur.
In women, symptoms can be more subtle and are often mistaken for a bladder or vaginal infection. They may include painful urination, increased vaginal discharge, or vaginal bleeding between periods. Rectal infections can occur in both men and women, leading to symptoms like anal discharge, itching, or painful bowel movements. Pharyngeal, or throat, infections are also possible and are frequently asymptomatic.
If gonorrhea is not treated effectively, it can lead to serious and sometimes permanent health complications. In women, the infection can spread to the reproductive organs, causing Pelvic Inflammatory Disease (PID). PID can result in the formation of scar tissue and abscesses in the fallopian tubes, leading to chronic pelvic pain, infertility, and an increased risk of ectopic pregnancy. In men, untreated gonorrhea can lead to epididymitis, an inflammation of the tube at the back of the testicles, which can also cause infertility in rare cases.
In rare instances, the infection can spread into the bloodstream, a condition known as Disseminated Gonococcal Infection (DGI). DGI can affect joints, causing a form of septic arthritis, or lead to skin lesions and, in severe cases, life-threatening conditions like meningitis or endocarditis. The potential for these severe outcomes is heightened when the infection is caused by a drug-resistant strain.
Current Treatment and Prevention Methods
Due to widespread antibiotic resistance, treatment options for gonorrhea are now limited. The U.S. Centers for Disease Control and Prevention (CDC) currently recommends a single, higher-dose injection of the antibiotic ceftriaxone. Previously, treatment involved a combination of an injectable and an oral antibiotic (azithromycin), but growing resistance to azithromycin led to a change in these guidelines in 2020.
Given the threat of untreatable gonorrhea, follow-up with a healthcare provider is important to ensure the infection has been cured. This “test of cure” is particularly advised for throat infections, which can be harder to treat, or if symptoms persist after treatment. The development of new antibiotics is slow, making the preservation of current treatments a high priority.
Preventing the spread of gonorrhea is fundamental to controlling the public health threat.
- Use condoms consistently and correctly during any form of sexual contact to reduce the risk of transmission.
- Get regular screening for sexually transmitted infections, especially if you have new or multiple partners.
- Notify all recent sexual partners if an infection is diagnosed so they can also be tested and treated. This practice, known as partner notification, helps break the chain of transmission.
- Abstain from sexual activity until both the infected individual and their partners have completed treatment.