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How Big of a Threat is Drug-Resistant Gonorrhea?
I spoke with an infectious disease specialist to find out how serious drug-resistant gonorrhea really is.
Garco B
February 26, 2025
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Across sixteen states, billboards have been popping up warning passersby of the dangers of drug-resistant gonorrhea. The billboards are one of several eye-catching campaigns initiated by the AIDS Healthcare Foundation. This nonprofit organization provides cutting-edge medicine and advocacy to patients in need, regardless of ability to pay. Their aim in launching the campaigns was not only to raise awareness of sexually transmitted infections, but also to start conversations around the topic. While they’ve certainly succeeded on the latter front, the question remains: how big of a threat is drug-resistant gonorrhea?
How is Antibiotic Resistant Gonorrhea Treated?
Typical cases of gonorrhea are treated using a single injection of ceftriaxone, with multiple other drugs, such as ceftizoxime, cefoxitin, and cefotaxime, also proving effective. The cause for concern comes when that first-line treatment fails to cure a case of gonorrhea and alternative medications or injections need to be used. In these cases, the typical symptoms of gonorrhea, like painful urination, unusual discharge, painful or swollen testicles, or vaginal bleeding, may persist even after receiving treatment.
Also of concern are the asymptomatic cases, in which patients exhibit no symptoms, but continuously put their sex partner(s) at risk. Drug-resistant or antibiotic-resistant strains of gonorrhea are rare, but becoming increasingly more common in other parts of the world; namely, China and the UK.
How Many Cases Are There?
Between 2017 and 2022, the number of cases in which ceftriaxone failed to treat gonorrhea approximately tripled in China. Since 2015, there have been approximately 31 cases of ceftriaxone-resistant gonorrhoea in England, including 7 of which were resistant to multiple other approved treatments. To date, there have only been three cases of drug-resistant gonorrhea detected in the US so far.
In 2023, the Massacheusetts Department of Public Health announced it had recorded the first two cases of antibiotic resistant gonorrhea in the country. The agency also noted that genetic markers for antibiotic resistance were previously detected in Nevada. Each of these three cases was eventually successfully treated using ceftriaxone, but the announcement indicates that more than one injection was likely used in one or more of these cases, indicating an increased level of resistance to the first-line treatment.
While drug or antibiotic resistance may sound like a scary term, it doesn’t mean that an infection has become completely incurable. When bacterial infections like gonorrhea develop antibiotic resistance, they become “logistically a little harder to deal with,” according to Andreas M. Kogelnik, MD, PhD, a director, internal medicine and infectious diseases specialist at the Open Medicine Institute. When asked about how difficult it could be to treat a case of antibiotic-resistant gonorrhea, Dr. Kogelnik noted, “There are options and there are ways to combine things and actually in some cases, we can go back into the older arsenal of antibiotics and get an injectable, or move back into IV treatment.” Resistance simply indicates that the infection will be more difficult and take longer to treat.
What Are We Doing About it?
The CDC continuously monitors data that may indicate treatment failures in its Antibiotic Resistance Threats Reports. Following its 2019 edition, the CDC, in partnership with two state health departments, expanded a drug-resistant gonorrhea surveillance program beyond the typical STI clinics and into emergency departments, where more cases of STIs are detected and treated.
What Can You Do to Protect Yourself?
Typical safe sex practices can help protect you and your partners from transmitting sexually transmitted infections like gonorrhea. These include:
Abstaining from vaginal, anal, or oral sex. This is the only way to completely avoid STIs.
Reducing your number of sex partners.
Regular testing. You and your partner(s) should get tested and share your results.
Being in a mutually monogamous relationship with a partner who has been tested and does not have an STI.
Using condoms the right way every time you have sex.
You can also speak with your doctor about a prescription for doxy PEP, which may be able to eliminate a gonorrhea infection if taken within 72 hours of a risky event. Doxy PEP uses the same antibiotic that doctors and clinicians use to treat the most common STIs, doxycycline. Although many strains of gonorrhea have already developed resistance to doxycycline, doxy PEP has shown to be about 50% effective at preventing gonorrhea infection when taken as prescribed.
Does Doxy PEP Contribute to Antibiotic Resistance?
So far, there is no evidence to support doxy PEP prescriptions leading to the development of antibiotic-resistant strains of gonorrhea. According to the CDC, “Current data suggest an overall benefit of the use of doxy PEP, but potential risks related to the development of resistance and changes in the microbiome will need to be monitored.” For now, doxy PEP is safe and effective for lowering your risk of gonorrhea and other STIs, while testing for the infections helps officials monitor drug resistance and keep communities safe.
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