Gonorrhea is a sexually transmitted infection (STI) that can infect both men and women. It is caused by the bacterium Neisseria gonorrhoeae. Super gonorrhea is a strain of gonorrhea that has become resistant to many commonly used antibiotics, making it more difficult to treat. Cases of super gonorrhea have been reported in many countries around the world. If left untreated, gonorrhea can lead to serious health problems, so it is important to get tested and seek treatment if infected. Here is an overview of how super gonorrhea is treated:
What antibiotics can treat super gonorrhea?
Super gonorrhea has developed resistance to older antibiotics like penicillin, tetracycline, and fluoroquinolones. The current recommended treatment is with dual therapy using the antibiotics ceftriaxone (an injectable cephalosporin) and azithromycin (an oral macrolide). This dual therapy has been effective for treating most cases of drug-resistant gonorrhea to date. However, there have been some reports of cases with decreased susceptibility even to ceftriaxone, indicating that resistance continues to evolve.
Are there alternative treatments if standard antibiotics fail?
If the recommended ceftriaxone/azithromycin treatment fails, the CDC recommends considering several alternative antibiotic regimens:
- Gentamicin (an aminoglycoside) plus azithromycin
- Gemifloxacin (a fluoroquinolone) plus azithromycin
- Cefixime (a cephalosporin) plus azithromycin or doxycycline
There are also some newer antibiotics in development or clinical trials that may be useful for treating extensively drug-resistant gonorrhea in the future, such as zoliflodacin.
How can treatment failure and resistance be prevented?
To prevent antibiotic resistance in gonorrhea, it is important to:
- Take all prescribed medication properly and completely (don’t stop early even if symptoms go away).
- Avoid unprotected sexual contact until treatment is complete and tests show the infection has cleared.
- Ensure partners are tested and treated as well to prevent reinfection.
- Have frequent STI testing if at ongoing risk.
- Researchers are also working to develop new antibiotics, alternative treatments, and gonorrhea vaccines.
Proper condom use and safe sexual practices can also help prevent transmission of drug-resistant gonorrhea strains. Public health efforts to expand testing, improve treatment adherence, and contact tracing of sexual networks will also be key.
Testing and diagnosis
Accurate testing is important to diagnose super gonorrhea, guide treatment, and prevent spread. Here is information on gonorrhea testing options:
Who should get tested for gonorrhea?
The CDC recommends gonorrhea testing for:
- Sexually active women under age 25, especially if at risk.
- Older women if they have new sexual partners, multiple partners, or other risks.
- Sexually active gay, bisexual and other men who have sex with men.
- Anyone with an infected sexual partner.
- Pregnant women.
People with gonorrhea symptoms like discharge, burning urination, or pelvic pain should also get tested. Retesting several months after treatment is important to confirm the infection has cleared.
What are the testing methods for gonorrhea?
Gonorrhea can be detected through:
- Nucleic acid amplification tests (NAAT) – The preferred method, detects gonorrhea DNA in urine, genital, or throat samples. Highly accurate.
- Culture – Involves growing bacteria from a sample. Allows antibiotic sensitivity testing but less commonly used now.
- Gram stain – Can detect gonorrhea under a microscope but not as accurate as NAAT or culture.
NAAT urine tests are easy and non-invasive but may miss some infections. Swabs of the cervix, urethra, rectum, or throat may be recommended in some cases for more accurate detection.
Are special tests needed for super gonorrhea?
Culturing the bacteria allows antibiotic susceptibility testing which is important in monitoring for drug resistance. Some specialized tests can also check for genetic markers of resistance. However, most gonorrhea testing now relies on easier NAAT methods. Ask your doctor about susceptibility testing if standard treatment fails.
Complications of untreated super gonorrhea
Super gonorrhea requires prompt treatment to avoid potentially severe complications:
Complications in women
- Pelvic inflammatory disease
- Scarring of the Fallopian tubes
- Increased risks of ectopic pregnancy and infertility
- Pelvic abscesses
Complications in men
- Epididymitis (inflamed testicles)
- Prostate gland infections
- Urethral stricture (narrowing of the urinary tract)
Other possible complications
- Disseminated gonococcal infection (spread of infection to joints, skin, heart)
- Eye infections potentially leading to blindness if untreated
- Increased risk of HIV transmission
Pregnant women with gonorrhea can pass the infection to their baby during childbirth, causing eye infections or other problems. Prompt prenatal treatment lowers this risk.
Prevention of super gonorrhea
To help prevent the spread of antibiotic resistant gonorrhea strains:
- Use condoms correctly every time you have sex.
- Limit sexual partners and avoid anonymous partners.
- Get tested regularly if sexually active, especially with new partners.
- Complete gonorrhea treatment and ensure partners get treated before resuming unprotected sex.
- Avoid unprotected oral, anal, and vaginal sex if either partner has symptoms or may be infected.
Developing new antibiotics and an effective gonorrhea vaccine will also be key prevention strategies going forward.
Conclusion
Super gonorrhea is an emerging public health threat as gonorrhea bacteria develop resistance to standard antibiotics. Dual therapy with ceftriaxone and azithromycin is currently recommended, with close monitoring for treatment failures. Improved testing, contact tracing, research into new treatments, and prevention awareness will be crucial to control drug-resistant gonorrhea. Getting tested and treated quickly, avoiding unprotected sexual contact if infected, and encouraging partners to get treated as well are important steps everyone can take to prevent super gonorrhea complications and transmission. Ongoing condom use and safer sexual practices are vital prevention measures. Public health strategies promoting gonorrhea awareness, testing access, treatment, and vaccine development will all be needed to meet this challenge.