Yes, Super Gonorrhea Is Real and It’s Gonna Get Worse

An illustration of Neisseria gonorrhoeae bacteria, the cause of gonorrhea.

An illustration of Neisseria gonorrhoeae bacteria, the cause of gonorrhea.
Illustration: Alissa Eckert/CDC

Over the weekend, a particularly awful pair of words started trending on social media: super gonorrhea. That’s because the World Health Organization recently warned that the pandemic is helping fuel the rise of antibiotic-resistant bacteria, including the bacteria that cause gonorrhea. Unfortunately, the situation is only likely to get worse.

Antibiotic resistance has been a slow-brewing crisis for decades, but the effects are finally becoming hard to ignore. Currently, so-called superbugs are thought to kill around 35,000 Americans annually, as well as 700,000 people globally.

One of the more worrying superbug threats today is Neisseria gonorrhoeae, the namesake bacteria that cause gonorrhea. Gonorrhea isn’t usually deadly and often has no symptoms, but if left untreated, it can lead to complications like arthritis, joint pain, and skin rashes, as well as infertility and chronic pelvic pain. The bacteria can also be passed from a mother to her baby during delivery, triggering an infection that can be fatal or cause serious problems like blindness. Notable symptoms include a green or yellow discharge from the genitals and pain while urinating.

These bacteria are scary because they’re becoming impervious to the first-line antibiotics used to treat them. In 2018, UK doctors reported finding a man with the first known case of gonorrhea that was highly resistant to the combination therapy used in most countries as standard treatment: the antibiotics ceftriaxone and azithromycin. Though the man’s gonorrhea was treatable with another antibiotic, the case confirmed experts’ worst fears. Other cases of super gonorrhea, as well as other highly resistant sexually transmitted infections, have been documented since.

Throughout this year, experts with the World Health Organization and elsewhere have been sounding the alarm over antibiotic resistance becoming worse due to the pandemic. For one, doctors have been routinely prescribing antibiotics to hospitalized patients with covid-19, a disease caused by a virus (antibiotics, as a rule, don’t work against viruses). Ostensibly, this is done because hospitalized patients can develop secondary infections caused by bacteria. Early research had also suggested that the antibiotic azithromycin might have an added antiviral effect, possibly in combination with other drugs like hydroxychloroquine.

Since then, though, studies have found that azithromycin, taken alone or with hydroxychloroquine, hasn’t had any lifesaving impact on covid-19 patients. Other research has found that doctors are usually prescribing antibiotics to patients without any evidence that they have bacterial infections.

That brings us to last week, when UK outlet The Sun reported on the WHO’s warning about gonorrhea. In addition to the above issues, the WHO also noted that the pandemic is likely making people delay STI testing and medical care, raising the risk that people will either never find out about their gonorrhea or even try to improperly self-medicate. The misuse and overuse of antibiotics, particularly azithromycin, is only adding more dynamite to the powder keg that is super gonorrhea.

“Such a situation can fuel emergence of resistance in gonorrhea,” a WHO spokesperson told The Sun.

What’s worse is that rates of gonorrhea and other STIs have risen in many places recently. The U.S., for instance, had a record number of STIs reported in 2018, with cases of gonorrhea climbing for the fifth straight year. It’s possible (even likely) that the pandemic has dampened many people’s sexual activity this year. But antibiotic-resistant bacteria haven’t gone away, and cases of super gonorrhea and other highly resistant infections will undoubtedly continue to increase in the years to come.

There is still hope that enough newer antibiotics and other therapies can be developed in time to avoid the worst-case scenario, where common bacterial infections become as dangerous as they were a century ago. Scientists are also working on vaccines for diseases like gonorrhea. But there’s no one clear solution on the horizon, and the clock is running out. In 2014, a report commissioned by the UK government estimated that, if nothing was done, annual worldwide deaths from antibiotic-resistant infections would eclipse cancer deaths by 2050, with around 10 million dead a year. By then, super gonorrhea will be the least of our worries.