New antibiotic could stave off drug-resistant gonorrhoea

Drug-resistant gonorrhea is on the rise around the world, but a new antibiotic could buy us more time before completely untreatable strains of the bacteria known to potentially increase the risk of infertility emerge.

A sexually transmitted infection is believed to affect more than 80 million people worldwide annually. This happens when a bacterium Neisseria gonorrhea affects various parts of the body, including the anus, urethra and genitals. Common symptoms include a burning sensation when urinating and unusual discharge from the vagina or penis. If left untreated, it can lead to infertility and pregnancy loss.

The disease is usually treated with injectable ceftriaxone, the latest antibiotic that is effective against most N. gonorrhea strains, but the bacterium develops resistance to this drug. For example, the World Health Organization found that in 12 countries, including Thailand, South Africa and Brazil, about 5 percent of cases were ceftriaxone resistant in 2024. sixfold increase from 2022.

If ceftriaxone doesn't help, doctors usually turn to other antibiotics, but it's only a matter of time before completely incurable strains emerge. “We're running out of options,” he says Alison Luckey in the Global Partnership for Antibiotic Research and Development. “It's been decades since a drug for gonorrhea was approved.”

In an attempt to stop this growing threat, researchers previously discovered that gepotidacin, an antibiotic tablet used against urinary tract infections, can effectively treat gonorrheaThe US Food and Drug Administration (FDA) is expected to decision to approve the drug in the US today. But since bacteria typically develop resistance to new drugs, the more treatment options we have, the better, Luckey says.

Now she and her colleagues have tested another drug, zoliflodacin, which was specifically designed to treat drug-resistant gonorrhea. Researchers randomly assigned 744 people with gonorrhea – from the United States, South Africa, Thailand, Belgium and the Netherlands – to receive either zoliflodacin or a combination treatment including ceftriaxone and another antibiotic called azithromycin.

Taking a swab from the participants' cervix or urethra after an average of six days, the researchers found that zoliflodacin cured about 91 percent of infections, compared with 96 percent among those who received standard treatment. This means there was no significant difference between treatments. Side effects such as headache and nausea were similar and transient in both groups.

The vast majority of the 744 cases were caused by strains not resistant to ceftriaxone or azithromycin. But previous research has shown that in a laboratory dish Zoliflodacin is effective against strains of gonorrhea that are resistant to all standard antibiotics.. The findings therefore add to evidence that zoliflodacin may offer a new approach to fighting gonorrhea, not only as a first-line treatment, but also potentially in cases where standard medications fail, Luckey said. “In places where there is a high risk of resistance, there may be a desire to use it earlier as a first-line treatment,” she says. What's more, the drug, taken orally, could be a more convenient way to treat gonorrhea than ceftriaxone, which some people avoid because of a fear of needles, she says.

The researchers have already submitted their data to the FDA, which is expected to make an approval decision on Dec. 15, Luckey says.

If it proves positive, approvals in other countries, including the UK, Europe and Asia, will soon follow, he says. Charlotte-Eva Short at Imperial College London, which was not involved in the study.

Along with ongoing gonorrhea vaccination efforts, The UK recently began rolling out the meningitis group B gonorrhea vaccineThe availability of two new drugs could be a turning point in the fight against drug-resistant gonorrhea, Short says. “This is great news,” she says. “We have yet to see at the population level what this might mean, but if we approach it from two different directions – we have prevention and we have treatment – ​​we can have a greater impact on reducing resistance.”