Why is antibiotic resistance in gonorrhoea such a concern?
Neisseria gonorrhoeae — the bacterium that causes gonorrhoea — has shown a remarkable ability to develop resistance to antibiotics over decades. It has successively evolved resistance to penicillin, tetracyclines, fluoroquinolones, and earlier cephalosporins. We are now at a point where the treatment options are limited, and cases of extensively drug-resistant (XDR) gonorrhoea that are very difficult to treat have been identified globally.
What is the current recommended treatment?
In the UK, the current first-line treatment recommended by BASHH is a single intramuscular injection of ceftriaxone (a third-generation cephalosporin). In some regions, this is combined with oral azithromycin to provide dual therapy. For uncomplicated urogenital gonorrhoea, a 500mg dose of ceftriaxone is used; higher doses are recommended for pharyngeal (throat) infections, which are harder to treat. Oral antibiotics alone are no longer recommended as first-line treatment.
What should you do if you are diagnosed with gonorrhoea?
You should attend a sexual health clinic to receive treatment rather than relying on over-the-counter or online antibiotics. Clinics can culture a sample to check which antibiotics your infection responds to, administer the injection, and advise on partner notification. A test of cure — retesting 2 weeks after treatment — is standard practice to confirm that the infection has cleared, especially for throat infections.
How does gonorrhoea develop resistance?
Resistance develops when bacteria are exposed to an antibiotic but are not completely killed — surviving bacteria can pass on genetic mutations that confer resistance. This is accelerated by incomplete courses of treatment, using the wrong antibiotic, or self-treating with antibiotics obtained without a prescription. Global travel also spreads resistant strains rapidly across countries.