Could Gonorrhea Become Incurable?

For years, gonorrhea and other sexually transmitted infections (STIs) have been easily treated with antibiotics. Antibiotics are so widely used today that clinicians are quick to prescribe them for many infectious diseases.

The incidence of gonorrhea has been on the rise since 2006, and the STI now affects 78 million individuals each year, according to the World Health Organization (WHO). However, treatment options for this curable disease are dwindling.

In a recent report, the WHO warned that gonorrhea is on its way to becoming untreatable because of antibiotic resistance. Quinolones, an entire class of antibiotics used to treat gonorrhea, are no longer recommended for this indication because widespread levels of quinolone-resistant strains of gonorrhea have emerged worldwide, rendering these antibiotics useless against this STI.

Instead, the WHO is recommending the use of cephalosporins, another class of antibiotics, but even these drugs are prone to resistance in the future. Back in 2012, the CDC advised clinicians to stop prescribing cephalosporins to treat gonorrhea. As an alternative, the CDC recommended the combination of 2 antibiotics, ceftriaxone and azithromycin, as a treatment. However, a CDC analysis from July 2016 warned that bacteria could eventually become resistant to both antibiotics.

In 2011, a super-resistant gonorrhea strain found in Japan initiated the emergence of untreatable gonorrhea. The strain, H041, was as much as 8 times more resistant to doses of ceftriaxone compared with previous gonorrhea strains, NPR reported.

“Gonorrhea used to be susceptible to penicillin, ampicillin, tetracycline, and doxycycline—very commonly used drugs. But, one by one, each of those antibiotics—and almost every new one that has come along since—eventually stopped working,” Jonathan Zenilman, MD, who studies infectious diseases at Johns Hopkins University, told NPR. “One reason is that the bacterium that causes gonorrhea can mutate quickly to defend itself.”

In some countries, evolving strains of gonorrhea have already become resistant to the newly recommended class of antibiotics.

“If this was a person, this person would be incredibly creative,” Dr. Zenilman continued. “The bug has an incredible ability to adapt and just develop new mechanisms of resisting the impact of these drugs.”

Health officials are concerned that the overuse of antibiotics to treat other infections, such as urinary tract infections, will cause more widespread, drug-resistant strains of gonorrhea to develop, NPR reported. These concerns are also rooted in the long-term health problems that untreated gonorrhea can cause, such as pelvic inflammatory disease and ectopic pregnancies in women.

If treatment options keep running out, could gonorrhea become incurable? Fortunately, novel treatment options are constantly being researched and developed. According to NPR, the US government is contributing millions of dollars through the CDC and National Institutes of Health to develop new antibiotics and combat resistance.