Why gonorrhoea is becoming 'untreatable'

Health experts are warning that a new "super gonorrhoea" could prove impossible to treat after the number of cases of the sexually transmitted infection hit a record high.

Data from the UK Health Security Agency (UKHSA) showed there were 85,223 cases diagnosed in England in 2023 – the highest number since records began in 1918 and a 7.5% increase on the previous year.

However, a new study by the agency found that more people are being infected with a strain that is proving resistant to conventional treatments and warned that gonorrhoea could become untreatable. 

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Not responding to treatment

Usually gonorrhoea is easily cured with an antibiotic called ceftriaxone. Over the last few years, however, experts have noticed a rise in the number of cases proving resistant to it.

As ceftriaxone is the first-line antibiotic used to treat gonorrhoea in England, resistance can make treatment difficult, said the Daily Mail, "especially for gonorrhoea infections in the throat". 

There were nine cases of ceftriaxone-resistant gonorrhoea infections reported between 2015 and 2022, but that rose to 15 for the period June 2022 to May 2024, said the UKHSA.

In addition, one-third of the cases were "extensively drug-resistant", meaning they also did not respond to the second line of treatment.

Fears for the future

The increasing number of cases was "concerning", said the study's authors, as it raised the chance of "wider spread and treatment challenges".

"Gonorrhoea is becoming increasingly resistant to antibiotics, risking the possibility of it becoming untreatable in the future," Dr Helen Fifer, one of the authors, said. "Condoms are the best defence, but if you didn't use one with a recent new or casual partner, get tested to detect the infection and prevent onwards transmission."

Professor Matt Phillips, president of the British Association for Sexual Health and HIV, said: "The rise of antibiotic-resistant gonorrhoea infections in England is a worrying trend that must be addressed with immediate action. 

"Antibiotic resistance of STIs poses an increasingly major public health threat, which can create physical and psychological harms and place additional demands on other parts of the NHS."

A global worry

Gonorrhoea is a sexually transmitted infection (STI) that, if untreated, can lead to infertility, said Sky News. 

It is caused by bacteria called Neisseria gonorrhoeae or gonococcus, which is found in the semen or vaginal fluid of infected people. It can also be passed from mother to baby during birth, but can be treated during pregnancy with antibiotics.

Symptoms can include a thick green or yellow discharge from the vagina or penis, pain when urinating or tenderness in the lower abdomen. However, some people do not experience any symptoms at all.

It is not only the UK that is experiencing a rise in super gonorrhoea. Most of the 15 cases reported in England – all in heterosexual patients, mainly in their 20s – had been acquired abroad. Nearly all the cases had an epidemiological link to the Asia-Pacific region, said the study's authors, and countries including China, Cambodia and Vietnam were reporting “worryingly high levels of ceftriaxone resistance”, said The Telegraph.

Last year, the US also reached a "grim landmark", said Ars Technica, when two unrelated patients in Massachusetts were found to have gonorrhoea infections with "complete or reduced susceptibility to every drug in our arsenal". "Little now stands between us and untreatable gonorrhoea,” the US Centers for Disease Control and Prevention "bluntly notes".