A dreaded superbug nightmare has become reality. A UK man is believed to have the first confirmed case of gonorrhea highly resistant to the only two front-line drugs available against it.
Doctors have been waiting for cases of highly resistant gonorrhea, caused by the bacterium Neisseria gonorrhoeae, above, to show up. Now one definitely has.Image: National Institute of Allergy and Infectious Diseases, National Institutes of Health (CC BY-NC 2.0)
On Thursday, Public Health England announced that its lab had detected the case. The anonymous patient is a heterosexual man who visited a doctor in England some time earlier this year.
Following his diagnosis, the man's strain was found to be resistant to the antibiotics ceftriaxone and azithromycin, which are recommended to be taken together as a combination therapy in many countries, including the US (in others, ceftriaxone and its cousins are the sole front-line drugs recommended).
Afterward, he was given another antibiotic known as spectinomycin. But though testing showed the gonorrhoea had disappeared from his genitals, it still survived in his throat. He's currently on another antibiotic called ertapenem, administered through IV, which seems to be working for now. Doctors plan to check back in mid-April to confirm his status.
"This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics," Gwenda Hughes, head of the sexually transmitted infection section at Public Health England, told CNN.
Doctors have been waiting for the other shoe to drop when it comes to drug-resistant gonorrhoea. Many cases are already resistant to azithromycin and related antibiotics. To help delay the inevitable, the Centres for Disease Control and Prevention recommended a combination therapy with the injectable ceftriaxone as the standard treatment in 2010. But by 2016, we had already started seeing treatable strains of gonorrhoea building up resistance to ceftriaxone within the US.
In 2017, a report from the World Health Organisation found the same was happening globally in at least 50 countries. The report also noted three cases detected recently in France, Japan, and Spain described as "untreatable".
The three case reports cited by the WHO seem to describe strains of gonorrhea resistant to ceftriaxone but not necessarily ceftriaxone and azithromycin taken at the same time. The WHO has not immediately responded to a request for comment regarding how these cases might differ from the UK case.
The bacteria that causes gonorrhoea, Neisseria gonorrhoeae, can reside in your genitals, throat, and rectum. And though it often comes without any noticeable symptoms, signs can include a green or yellow discharge from the genitals, pain while urinating, and for women, bleeding between periods.
Left untreated, it can cause genital scarring and inflammation that may eventually lead to infertility in both men and women, while making it easier to develop other infections like HIV. It can also spread from mother to child in the womb, raising the risk of birth defects or miscarriage.
It's estimated that there are about 78 million new infections of gonorrhoea worldwide a year, a growing number aided not only by resistance, but also reduced condom use, inconsistent STD testing, and increasing travel. The UK patient is believed to have caught it from a woman while travelling in Southeast Asia a month before his symptoms began.
His female partner in the UK was also screened, but thankfully tested negative.
There's only a bit of light at the end of the tunnel. Three new antibiotics are in development right now, according to the WHO, though the furthest ahead, solithromycin, has run into repeated stumbles in getting approved.
Another drug, zoliflodacin, entered a Phase III trial last summer, while the last, gepotidacin, recently cleared a Phase II trial.