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Gonorrhea is becoming unstoppable; highly resistant cases found in US

"Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of gonorrhea prevalence in men who have sex with men." – Frequent Transmission of Gonorrhea in Men Who Have Sex with Men, National Library of Medicine

ARS TECHNICA – The most highly drug-resistant cases of gonorrhea detected in the US to date appeared in two unrelated people in Massachusetts, state health officials announced Thursday.

The cases mark the first time that US isolates of the gonorrhea-causing bacterium, Neisseria gonorrhoeae, have shown complete resistance or reduced susceptibility to all drugs that are recommended for treatment.

Fortunately, both cases were successfully cured with potent injections of the antibiotic ceftriaxone, despite the bacterial isolates demonstrating reduced susceptibility to the drug.

Ceftriaxone is currently the frontline recommended treatment for the sexually transmitted infection.

But health officials said the cases are a warning. “N. gonorrhoeae is becoming less responsive to a limited arsenal of antibiotics,” they said.

“The rate of gonorrhea is much higher in men who have sex with men than in heterosexuals.”

Brewing resistance

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For years, global surveillance data collected by the World Health Organization has shown that gonorrhea is becoming more and more resistant to our entire lineup of drugs, including frontline drugs like ceftriaxone.

Though surveillance is spotty globally, a study of WHO’s 2017–2018 data published in 2021 found N. gonorrhoeae isolates with decreased susceptibility or resistance to ceftriaxone have turned up in 21 of the 68 reporting countries, or 31 percent.

Resistance against alternative antibiotics was even higher. Among the 61 countries reporting data on an alternative antibiotic, azithromycin, 51 countries (84 percent) reported resistance.

And of 51 countries reporting data on the alternative antibiotic treatment, cefixime, 24 countries (47 percent) reported resistance. For ciprofloxacin, an antibiotic largely abandoned as a gonorrhea treatment due to resistance, all 70 reporting countries found resistance.

“In many countries, ciprofloxacin resistance is extremely high, azithromycin resistance is rapidly increasing, and resistance or decreased susceptibility to ceftriaxone and cefixime continue to emerge,” the WHO said in 2021. “Without new gonorrhoea treatments, there will be people with gonorrhoea infections that will be difficult to treat and cure.”

“Over time, gonorrhea can lead to pelvic inflammatory disease, severe pain, and fertility problems.”

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The agency wasn’t exaggerating. Last year, WHO added that reports of gonorrhea treatment failure are stacking up …

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