Gonorrhea is a common sexually transmitted disease (STD). Recently, officials have detected a new strain of antibiotic resistant gonorrhea, sometimes called “super gonorrhea.” What is super gonorrhea? Should you be worried about catching it? How will you know if you have super gonorrhea?
Super gonorrhea is a strain of drug resistant gonorrhea. It cannot be treated using any known antibiotics. At the moment, there have only been a few known cases of this untreatable gonorrhea reported in various countries around the world. However, public health officials are worried that super gonorrhea will spread widely in the next few years.
The emergence of this “gonorrhea super bug” is concerning because gonorrhea can cause serious complications. When it’s left untreated, gonorrhea can spread into the bloodstream and can impact the joints, heart valves, and brain. This can cause disability and even death, making super gonorrhea potentially a deadly strain of gonorrhea. As super gonorrhea spreads, there will likely be more and more cases of this type of infection.
The appearance of gonorrhea that is resistant to all known antibiotics is new. However, resistance to antibiotics has been developing in gonorrhea bacteria for decades, even before super gonorrhea was ever reported. In other words, gonorrhea has slowly been becoming “super” for many years.
For example, as reported by the CDC, gonorrhea developed resistance to penicillin in the 1980s. In the 1990s, resistance to a group of antibiotics called fluoroquinolones was reported. In general, after doctors start widely using a different antibiotic to treat gonorrhea, the bacteria develop resistance to it within a few years. The appearance of super gonorrhea is simply the end point of this process.
Super gonorrhea is transmitted in the same way as regular gonorrhea. It’s spread through sexual contact, including vaginal, oral, and anal sex. Super gonorrhea does not necessarily spread any more easily than regular gonorrhea does. What makes it “super” is not its ability to spread, but its ability to evade antibiotic treatment once the infection is established. Condoms are still very effective in preventing the spread of gonorrhea, including super gonorrhea.
Super gonorrhea is ultimately the same infection as regular gonorrhea. Although it’s harder to treat, it’s caused by the same type of bacteria and leads to the same symptoms. The symptoms of the initial gonorrhea infection can include:
Many people with gonorrhea, including super gonorrhea, don’t have any symptoms. This is why it’s very important to use protection every time you have sex outside of a mutually monogamous relationship, even if your partner doesn’t have any symptoms of an STD. This is also why it’s important to get tested for STDs, including gonorrhea, on a regular basis. Even if you don’t notice any symptoms, you could still have super gonorrhea.
Although gonorrhea has developed resistance to many antibiotics, the majority of gonorrhea cases still respond to an injectable medication called ceftriaxone. One dose, given through an injection into the arm, will usually still work against gonorrhea. However, with super gonorrhea, there is no known antibiotic that will work.
So far, there have only been a few reports worldwide of ceftriaxone-resistant gonorrhea, which cannot be treated by any known antibiotic. Nearly all of these cases have been pharyngeal gonorrhea – gonorrhea in the throat, which is acquired through oral sex. In general, gonorrhea in the throat is harder to treat than gonorrhea in the genitals or anus, and so it’s not surprising that this is where super gonorrhea showed up first.
We don’t yet know how widely super gonorrhea will spread. However, public health officials expect to see more and more cases worldwide over the next few years, including genital and anal infections as well as pharyngeal ones.
With all types of gonorrhea, including super gonorrhea, the infection often doesn’t cause any symptoms. Testing is the only way to know whether you have gonorrhea or any other STD. You can go to a clinic for testing, or you can choose to get a home STD test for more convenience. For both men and women, a urine test is the most commonly used type of test for gonorrhea.
If your test shows that you have gonorrhea, this doesn’t reveal whether it’s caused by super gonorrhea or not. A separate test can be done to check for antibiotic resistance in the bacteria. This test involves a culture, and so it takes a few days to give results. However, the culture test is not always performed. Often, if your test shows that you have gonorrhea, you will simply be given the recommended antibiotic treatment without the culture test. If the treatment doesn’t work, then antibiotic resistance testing will be performed, which will reveal if your infection is caused by super gonorrhea.
Each STD is different, and there’s no one treatment that will work for every STD. In fact, antibiotics are not always the right treatment for an STD. For example, for STDs caused by viruses, antibiotics will not be effective.
For gonorrhea, the strongest antibiotic currently is ceftriaxone, which is generally given as a single injection. This will work to treat most cases of gonorrhea, although super gonorrhea doesn’t respond to ceftriaxone.
If gonorrhea is left untreated, the bacteria can spread into the bloodstream, and from there to other parts of the body. This can lead to meningitis, which is inflammation in the covering around the brain and spinal cord. Meningitis is very serious and can cause brain damage and even death. Gonorrhea that has entered the bloodstream can also damage other body structures, including the joints and the heart valves.
Gonorrhea’s ability to spread throughout the body is what makes super gonorrhea such a concerning development. If we are not able to treat gonorrhea, then more people will be at risk for very serious infections.
Gonorrhea may cause discharge, and this discharge sometimes has a smell. The odor is sometimes described as “mushroom-like” or “pungent.” However, people with gonorrhea don’t always notice a smell. Other STDs, notably trichomoniasis, are more commonly described as creating a strong smell.
Whether or not you notice a smell isn’t a reliable way to know whether you have gonorrhea. Many people with gonorrhea don’t have any symptoms at all, and those who do have symptoms may or may not notice a smell. The only way to be certain about whether you have an STD is to get tested.
Some people experience symptoms from gonorrhea, while others do not. In those who do experience symptoms, they will usually become apparent within 2 to 5 days after acquiring the infection, although it can take as long as 30 days. Those who don’t have symptoms from the initial infection may still experience complications months or even years later. They can also transmit gonorrhea to their sexual partners.
Antibiotic-Resistant Gonorrhea. Centers for Disease Control and Prevention (2021). https://www.cdc.gov/std/gonorrhea/arg/default.htm. Accessed 8 Feb 2022.
Gonorrhea Laboratory Information: Disk Diffusion Susceptibility Testing. Centers for Disease Control and Prevention (2021). https://www.cdc.gov/std/gonorrhea/lab/diskdiff.htm. Accessed 8 Feb 2022.
Kueakulpattana N, Wannigama DL, et al. Multidrug-resistant Neisseria gonorrhoeae infection in heterosexual men with reduced susceptibility to ceftriaxone, first report in Thailand. Sci Rep 11, 21659 (2021). doi: 10.1038/s41598-021-00675-y
Multi-drug resistant gonorrhoea. World Health Organization (2021). https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea. Accessed 8 Feb 2022.
Tien V, Punjabi C, et al. Antimicrobial resistance in sexually transmitted infections. J Travel Med 2020 Feb 3;27(1):taz101. doi: 10.1093/jtm/taz101
Unemo M, Nicholas RA. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. Future Microbiol 2012 Dec;7(12):1401-22. doi: 10.2217/fmb.12.117