First antibiotic-resistant gonorrhea cases detected in the US

The United States faces an uphill battle against the disease.
Ameya Paleja
Gonorrhoea stock photo.
Gonorrhoea stock photo.


Two unrelated cases of a novel strain of gonorrhea, one showing resistant or reduced response to five classes of antibiotics, have now been reported in the U.S., a press release from the Department of Public Health (DPH) in Massachusetts said.

Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae. The organism once treatable with a dose of penicillin or other antibiotics has now gained resistance to them and can survive treatments used by clinicians to stop their spread.

Gonorrhea infections do not cause severe illness in the patients but do show clear symptoms such as painful urination, abnormal discharge from the penis or vagina, or also pain in the lower abdomen. Without treatment, the infection can also lead to fever or cause pain during sexual intercourse, as well as pus-like discharge from the rectum and anal itching if contracted through anal sex.

Cases in Massachussetts

The two unrelated cases were detected during the DPH's disease surveillance activities and were found to be a novel strain of the bacterium. The genetic markers found in the strain showed that it was likely to show a reduced response to antibiotics. The strain has previously been observed in countries in the Asia Pacific and in the U.K., the press release added, but never in the U.S.

In the U.S., the bacterium has developed resistance to the antibiotic azithromycin prompting health authorities to stop recommending it for the disease since late 2020, Gizmodo said in its report. Currently, only ceftriaxone, that too in higher doses, is the only treatment available.

Since the genetic markers suggested that the organism was likely to show a reduced response to antibiotics, the patients were administered even higher doses of ceftriaxone, which helped clear the infection.

The road ahead

Since the two cases do not have a clear connection, the DPH's Division of Sexually Transmitted Disease Prevention is now conducting contact tracing to see if other individuals have also acquired the infection.

Since the genetic markers seen in this strain have been previously reported in strains seen in other parts of the globe, it appears like antibiotic resistance is spreading rapidly. The number of cases of gonorrhea in the U.S. has been rising over the years with a 131 percent increase seen between 2009 and 2021. It could be likely that the antibiotic-resistant strains are also in circulation beyond a point where they could be contained.

The DPH has issued an alert to raise awareness about the strain, which recommends using laboratory culture testing for individuals who have symptoms of gonorrhea. This alert also recommends that individuals who have been given higher levels of ceftriaxone undergo follow-up tests to ensure that they have been successfully treated.

"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," said Margret Cooke, Public Health Commissioner in the press release.

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