Why Is Gonorrhea Getting Harder to Treat?

Guidelines have evolved to combat antibiotic-resistant gonorrhea.

Medically reviewed in December 2021

Updated on December 17, 2021

Gonorrhea is a sexually transmitted bacterial infection that can affect both men and women. In some cases, the infection can become quite serious.

The bacteria can infect the throat, rectum, and urethra. In women, it can also infect the cervix, uterus, and fallopian tubes, potentially causing pelvic inflammatory disease (PID). PID is a serious infection of the upper genital tract involving the uterus, fallopian tubes, and ovaries. Gonorrhea can also increase the risk of acquiring HIV.

In some cases, a pregnant person may pass the infection to their baby during birth. Gonorrhea can cause pain or burning during urination and discharge from the penis or vagina, but it's often asymptomatic, especially in women. 

Although medications have been used successfully for decades to cure cases of gonorrhea, it's become more difficult to treat in recent years.

Why is this the case?

The challenge of antibiotic resistance
According to the Centers for Disease Control and Prevention (CDC), gonorrhea bacteria has developed resistance to nearly every drug used against it in the past. The World Health Organization (WHO), meanwhile, has suggested that decreased condom usage and increased urbanization and travel around the world are contributing to this gonorrhea surge.

Based on a study of more than 5,000 samples in 2014, the CDC found that the bacteria that causes gonorrhea, Neisseria gonorrhoeae, was becoming increasingly resistant to a variety of antibiotics, including tetracycline, ciprofloxacin, and penicillin. Notably, there was an increase in resistance to the antibiotics used to treat gonorrhea, azithromycin and ceftriaxone.

Although the WHO and the CDC previously recommended dual therapy for gonorrhea with azithromycin and ceftriaxone, in 2020, the CDC updated their guidelines to recommend that only ceftriaxone be used. It was determined that the theoretical benefit of the combination therapy was outweighed by the decreasing effectiveness of azithromycin to fight the Neisseria gonorrhea bacteria.

How common is gonorrhea?
The CDC reports that each year, there are roughly 1,568,000 new cases of gonorrhea in the United States. It’s the second-most commonly reported bacterial communicable disease. Although gonorrhea is most common in young people aged 15 to 24, anyone who has unprotected sex is at risk for contracting the infection. To reduce the risk for contracting gonorrhea during sex, the CDC recommends using condoms.

As Neisseria gonorrhoeae becomes more resistant to antibiotics, meanwhile, cases of gonorrhea become harder to treat and can potentially become untreatable. Left untreated, gonorrhea can cause pain in the pelvis and abdomen, pregnancy complications including ectopic pregnancy, and infertility issues in both men and women. 

How to treat gonorrhea
As of 2020, the CDC recommends that gonorrhea treatment should consist of a single intramuscular injection of ceftriaxone. If a person's symptoms continue for more than a few days after treatment, a follow-up test should be given to be sure the infection was treated. People with gonorrhea should also be retested three months after treatment, regardless of whether they think their sexual partners were successfully treated, too.

The U.S. Preventive Services Task Force advises that all sexually active women ages 24 years or younger and women 25 years or older who are at increased risk for infection should be screened for gonorrhea. Your risk depends on whether you have or previously had a sexually transmitted infection, if you have multiple sex partners, or if you do not use condoms consistently if you’re not in a mutually monogamous relationship.

Talk with your healthcare provider about whether and how often it makes sense for you to be screened for gonorrhea. Always be sure to check in with any symptoms you may have. The sooner you can get effective treatment for gonorrhea, the better your chances of eliminating the infection and getting on with your life.

Sources:
Centers for Disease Control and Prevention. Gonorrhea Treatment and Care. Page last reviewed July 22, 2021.
World Health Organization. Antibiotic-resistant gonorrhoea on the rise, new drugs needed. July 7, 2017.
Centers for Disease Control and Prevention. Neisseria gonorrhoeae Antimicrobial Susceptibility Surveillance — The Gonococcal Isolate Surveillance Project, 27 Sites, United States, 2014. July 15, 2016.
Centers for Disease Control and Prevention. Gonococcal Infections Among Adolescents and Adults. Page last reviewed November 24, 2021.
Centers for Disease Control and Prevention. Gonorrhea – CDC Fact Sheet (Detailed Version). Page last reviewed July 22, 2021.
Centers for Disease Control and Prevention. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. Page last reviewed December 17, 2020.
U.S. Preventive Services Task Force. Chlamydia and Gonorrhea: Screening. Final Recommendation Statement. September 14, 2021.

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