‘Super Gonorrhea’ Is Here, But Don’t Worry—Yet

It appears the world has its first case of “super gonorrhea” that’s resistant to the common antibiotics-drug combination used to fight the infection, Public Health England reported earlier this week.

The patient, who’d had a steady partner but had contracted the infection from a “sexual encounter with a woman in south-east Asia,” visited a clinic for treatment earlier this year. He was treated with a one-two punch of the antibiotics commonly used to treat gonorrhea, azithromycin and ceftriaoxone, but it didn’t work. The man’s partner tested negative for the disease.

“We are investigating a case who has gonorrhea which was acquired abroad and is very resistant to the recommended first line treatment,” Gwenda Hughes, head of PHE’s sexually transmitted infections unit, told The Guardian.

Carolyn Deal is the branch chief of the National Institute of Allergy and Infectious Disease, a division of the National Institutes of Health.

Deal said that what we think of as “super gonorrhea” is scientifically termed as “multi-drug resistant gonorrhea.” “It means that the bacteria will not respond to what is the normal amount of antibiotic and drugs that is used to treat the infection,” she told The Daily Beast.

Specifically, what the British patient seems to be dealing with is Neisseria gonorrhoeae, a strain of the disease that is sometimes characterized by painful urination and a pus-like discharge from the penis, but can also be sneaky and show no symptoms at all.

What makes Neisseria gonorrhoeae particularly difficult to treat is the fact that it’s been shown to be resistant against penicillin and the normal blockade of antibiotics used to treat gonorrhea.

The emergence of antibiotic-resistant “super gonorrhea” isn’t a surprise, Deal said.

In 2013, the Centers for Disease Control and Prevention released a report that called antibiotic resistant gonorrhea “one of the three most urgent threats of its kind.” By 2015, the White House had released a National Action Plan that outlined a five-year plan (PDF), which included taking monthly surveillance of strains from men at 26 STD clinics to track how antibiotics were combating the disease.

That’s at the national level, as efforts have been underway worldwide to prevent gonorrhea from re-emerging as a major public health problem. In July 2017, Deal was part of an international group of researchers who published a roadmap in PLOS Med, detailing how “super gonorrhea” was something we had to prepare for.

According to the report, three chemical “entities” are in the midst of being developed to treat this newer form of gonorrhea, but they haven’t been approved by medical safety organizations like the Food and Drug Administration yet. The year prior, though, researchers from around the world banded together with the World Health Organization to create the Global Antibiotic Research and Development Partnership to draft potential ways to address the eventual emergence of “super gonorrhea.”

The group has a seven-year plan with extensive research proposals, and Deal said that she felt confident the public-health response would adequately respond to antibiotic resistant STDs like gonorrhea.

That seven-year WHO plan builds upon a 2015 announcement the organization made that predicted we might be returning to a pre-antibiotic era, noting that “there are not many new antibiotics in the pipeline that can replace the resistant and ineffective ones.”

“I think there has been a great awareness of funding for the entire area,” she said. “If you look at the efforts of our institute and other organizations around the world, there are efforts in developing new antibiotics and rapid diagnostics.”

Indeed, earlier this week, the executive director of the National Coalition of STD Directors published an op-ed in The Hill that cited the British case as “an alarm bell and a fair warning.” In late March, Congress—which had been steadily slashing funds for research—reversed course and actually increased funding by a few million dollars for STD research.

But the National Coalition of STD Directors is calling for about $70 million more to be tacked on to the CDC’s budget next year to continue looking into efforts to deal with drug resistant gonorrhea, among other STD-related concerns. “Over the last 15 years, STD prevention funding at the CDC has seen a $21 million reduction at the same time that we have seen dramatic increases in STDs,” a report points out, calling rates “epidemic.”

The British case, and the fact that he possibly contracted it from someone else, raises the question of whether there could be others walking around with this “super” form of gonorrhea and either not know it or not display signs of it. “That’s hard to say,” Deal said. “With Neisseria, they could be asymptomatic,” so that “someone could be infected and not know it.”

That’s what makes not only the development of drug programs important to help combat this emerging strain but also for countries to hold regular screenings for infectious diseases. “Think of it like the flu or common cold,” she added. “You might be exposed but you might not necessarily get sick.”

So should the British case make us anxious? Deal, for one, doesn’t think this is dangerous. “I think that if you look at the arc over the years, antibiotic resistance has routinely emerged. This is one point of that continuum.”