Drug-resistant Neisseria gonorrhoeae (the bacterium that causes gonorrhea) has become one of the most urgent antimicrobial resistant threats to public health worldwide. Clinicians expect to be confronted by rising rates of treatment failure in the years to come.
As gonorrhea rates rise and treatment options become more limited, researchers are calling for a more tailored approach that combines new diagnostics, rapid resistance testing, surveillance and additional treatment options for the sexually transmitted disease.
Dr. Lao-Tzu Allan-Blitz, an assistant professor in UCLA’s David Geffen School of Medicine’s Division of Infectious Diseases in the Department of Medicine, recently co-edited a supplement in the journal Clinical Infectious Diseases that outlines the threat and highlights recent advances in diagnostics and therapeutics that can help.
Why is gonorrhea becoming a growing concern?
Gonorrhea has become much more difficult to cure because the bacterium that causes it has developed resistance to every antibiotic previously used as a first-line treatment.
The impact is already substantial. More than 500,000 cases are reported each year in the United States, and an estimated 82 million occur globally. Clinicians predict that as resistance continues to spread, treatment failure will become more common.
And beyond the infection itself, untreated or inadequately treated gonorrhea can lead to serious health problems. Those includes pregnancy complications, neonatal blindness, pelvic inflammatory disease, infertility and increased HIV transmission.
How is the medical community responding?
The traditional "one-size-fits-all" treatment approach is no longer sustainable. New tests and treatment options are becoming available that could help clinicians choose the most effective therapy and slow the spread of resistant infections. Taking that personalized approach a step further, clinicians may increasingly consider factors such as where the patient is located, local resistance patterns and laboratory test results – to help determine the most appropriate treatment.
Several tools are used together to make treatment more precise. Those include rapid diagnostic tests, prediction of antimicrobial susceptibility based on bacterial genotypes, resistance surveillance and newer antibiotic options. The goal is to diversify the treatments used to slow the evolution of drug resistance while also matching patients with the treatment most likely to work, improving clinical outcomes.
What role could new diagnostic tests play?
New molecular tests can identify genetic markers linked to antibiotic resistance. Soon, those tests may allow clinicians to determine which treatments are most likely to work before prescribing them. That could improve cure rates, reduce treatment failures and help preserve the effectiveness of existing antibiotics.
Are new treatment options becoming available?
Yes. Two new therapies have recently been approved by the FDA for the treatment of gonorrhea, expanding the available treatment options. The next challenge is determining how to use these therapies in a way that provides broad access to patients while delaying the emergence of resistance for as long as possible.
What challenges remain?
Several important questions remain. Resistance-testing technologies are becoming available, but they must be made accessible to frontline clinicians. Public health systems also need stronger surveillance and monitoring programs to track resistance as it evolves.
Equitable access to new diagnostics and treatments will be critical to ensuring that all patients benefit from these advances.
What role does public health play?
Public health agencies are essential for tracking resistance trends, supporting surveillance programs, improving access to testing and treatment, and helping healthcare providers respond to emerging threats.
Without strong public health infrastructure, it will be much harder to control the spread of drug-resistant gonorrhea.
What are the next steps?
The immediate priorities are expanding access to rapid resistance testing, integrating these tools into routine care, evaluating how new therapies perform in real-world settings, and strengthening surveillance efforts worldwide.
Ultimately, the goal is to create a more flexible, personalized treatment approach that can adapt as resistance patterns continue to change.
