The rise of superbug gonorrhea

Gonorrhea is currently easily treatable with antibiotics. Emerging antibiotic resistance may soon change that. 

Gonorrhea is a common sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae that infects the throat, genitals, and rectum. Many cases are asymptomatic, but symptoms can include burning or discomfort when urinating, abnormal bleeding between periods, and swollen testicles. If left untreated, it can cause infertility. Gonorrhea can also be passed to newborns during vaginal birth and cause blindness in the baby. 

Breaking the last line of defence

Dr. Vanessa Allen, the chief of medical microbiology at Public Health Ontario, told The Strand, “[W]e have currently exhausted all but one of the widely available antimicrobials … to reliably treat gonorrhea. Pills alone are no longer reliable.” An injection called ceftriaxone is the remaining option.  

Unfortunately, recent reports from the World Health Organization (WHO), the European Centre for Disease Prevention and Control, the Centers for Disease Control and Prevention (CDC), and the British Association for Sexual Health and HIV (BASHH) show developing resistance to the last WHO–recommended treatment for gonorrhea: a dual antibiotic therapy of azithromycin and ceftriaxone.  

The first North American case of ceftriaxone–resistant gonorrhea was reported in Quebec in 2017. Fully resistant strains have already been reported in Europe in 2019. 

“There have been a few case reports of ceftriaxone–resistant gonorrhea in Canada in 2018; all of these to the best of our knowledge were directly imported from Asia,” said Allen.  

Without effective antimicrobial remedies, the treatment for gonorrhea would return to what it was in the 1930s, when patients were hospitalized and “given mechanical and heat treatments to try to get rid of the infection,” which were not always effective. 

“It is important to note that we are seeing a surge of disseminated infections with gonorrhea in Ontario and elsewhere in Canada, where the bacteria is causing infections of the blood and joints,” added Allen. “It is causing more severe complications and is more difficult to treat.”  

Changing treatments

With azithromycin resistance increasing in Europe, the UK has changed its recommended treatment for gonorrhea. The newly-released 2019 BASHH guideline for gonorrhea no longer recommends azithromycin and instead recommends an increased dose of ceftriaxone.  

The latest Canadian guideline (from 2013) recommends treatments including both azithromycin and ceftriaxone. 

Fast development of resistance 

Neisseria gonorrhoeae develops resistance faster than other STIs because of its biology, which allows the bacteria to pick up genes that resist antibiotics more easily and retain these genes between generations. Unfortunately, the global treatment strategy of using a single, near–universally effective drug to prevent the spread of potential infection has also contributed to the speed of sequentially developed resistance to previously effective drugs, says Allen. 

Prevention 

Researchers and health organizations worldwide continue to search for new drugs and treatments, and strive to better understand the development of antimicrobial resistance. 

Allen added that proposed strategies for the future include more specific diagnoses that allow for different drugs to be used when possible. That way, there is less selective pressure put on the bacteria by one drug.  

Using protection during intercourse is the best way to prevent the spread of gonorrhea, including antibiotic–resistant strains.  

It is also important to be tested for gonorrhea and abstain from sex during treatment. Infection of the throat is particularly difficult to treat because it usually presents no symptoms and is not always cured by ceftriaxone, according to Allen. 

Free condoms can be found at many locations on campus, such the Arts and Science Student Union (ASSU), outside the VUSAC office at Victoria College, and the Sexual Education Centre (SEC). They can also be found at sexual health clinics around Toronto, including Planned Parenthood Toronto on 36 Prince Arthur Avenue. These clinics, along with the UofT Health and Wellness Centre, also provide STI testing and other sexual health services. 

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