Last month, a man in the UK was reported to have one of the first documented cases of gonorrhea that was completely resistant to all antibiotics used to routinely treat the sexually transmitted infection, including azithromycin and ceftriaxone.
This antibiotic combo, which consists of a shot (ceftriaxone) and an oral drug (azithromycin), is one of the last relatively easy-to-take treatments for the sexually transmitted infection, which has slowly become resistant to just about every other antibiotic over the decades. It is the recommended treatment worldwide for gonorrhea.
The good news is that the UK man was recently cured after three days of intravenous treatment with another antibiotic called ertapenem, according to Public Health England. Intravenous drugs need to be administered in an IV drip in a health care setting, so they aren't easy to take — but at least it worked.
However, two additional cases of super gonorrhea were reported in Australia on April 17. Those cases also appeared to be resistant to all the antibiotics normally used to treat gonorrhea. Like the UK man, at least one Australian patient most likely acquired the case in Southeast Asia, but it's not a problem isolated to that region of the world.
Drug-resistant gonorrhea exists in all countries, and there have been signs that completely untreatable gonorrhea is looming in the US and many countries. However, these documented multi-drug resistant cases are new.
"The situation is being closely monitored by public health authorities," said the Australian Government Department of Health.
About 19% of people with gonorrhea in the US aren't getting the recommended combination of antibiotics, according to a new report from the US CDC.
Proper treatment is key to slowing the spread of drug-resistant gonorrhea, and the recommended treatment is still azithromycin and ceftriaxone. It usually works and is recommended for most uncomplicated cases of the STI.
A survey of about 75,000 people treated in the US in 2016 showed that 81% received the combo. (The researchers specifically looked at uncomplicated cases, meaning those in the lower genital tract, throat, or rectum that hadn't spread.) While that's good, it also means that not everyone in the US is getting the right treatment.
Treatment can vary depending on where you go. Although 91% of patients at STD clinics and 94% treated at family planning or reproductive health clinics got the drug combo, only 80% of people treated in other places (like their doctor's office) did so. Some patients received only one drug, or a different combination of antibiotics.
The CDC research team published the findings in the agency's Morbidity and Mortality Weekly Report.
"To date, we have not seen a confirmed treatment failure in the US when the recommended dual treatment has been used," study author Emily J. Weston, an epidemiologist in the CDC’s Division of STD Prevention, told BuzzFeed News by email. "However, we are observing warning signs of emerging antibiotic resistance in the United States and around the world."
"The findings in this report are a reminder that while there were relatively high levels of treatment adherence in a variety of healthcare settings, there is still room for improvement," she said.
Gonorrhea is the second most commonly diagnosed sexually transmitted infection in the US, after chlamydia — and cases are on the rise.
There were nearly 470,000 new gonorrhea cases in 2016, although there may be as many as 800,000 new cases each year as not all people know they are infected. Cases are on the rise and are more common in people aged 15 to 24, with the highest rates in men and women aged 20 to 24.
The infection is caused by a type of bacteria called Neisseria gonorrhoeae. Anyone who is sexually active can get gonorrhea, and the bacteria can infect the throat, vagina, or rectum.
Gonorrhea symptoms can be easy to miss — or it may cause no symptoms at all. Men may have a burning sensation while urinating, swollen testicles, or a white, yellow, or green penile discharge.
Women can have vaginal discharge, bleeding between periods, and a pain and burning while urinating. Rectal infections can cause discharge, bleeding, itching, and painful bowel movements.
The best way to prevent gonorrhea infections is to use latex condoms. Untreated gonorrhea can cause serious health problems, including infertility in women and, less often, in men. In women, it can cause pelvic inflammatory disease, long-term pelvic pain, and scarring.
In rare cases, the bacteria can lead to potentially life-threatening infections of the blood or joints.
"If you are treated for gonorrhea, it is important that all of your partners are treated. This can help protect you from being re-infected," said Weston. "If you completed your treatment and still have symptoms, you should see your healthcare provider."