The term “super gonorrhea” refers to the growing resistance to antibiotic treatments for bacteria that cause gonorrhea. This limits treatment options and can make this sexually transmitted infection (STI) much more difficult to cure.

Gonorrhea is one of the most common STIs, with nearly 650,000 cases in the United States in 2022. According to the World Health Organization (WHO), there were 82 million new infections worldwide in 2020.

Although medication to treat gonorrhea has been available for many years, the bacteria that cause the STI have become resistant to almost all types of previously effective drugs. Without treatment, gonorrhea can lead to severe health complications, including chronic pain and infertility.

This article discusses the rise of drug-resistant gonorrhea, including its symptoms, causes, diagnosis, and treatment. It also looks at what happens when treatment is ineffective and the outlook for the infection.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Super gonorrhea refers to gonorrhea’s growing resistance to standard treatment. Gonorrhea is a common STI that was previously treatable with various types of antibiotics.

Gonorrhea’s resistance to antibiotics dates back to the emergence of the drugs as a treatment for the infection. Over time, the bacteria that cause the infection, Neisseria gonorrhoeae, has grown resistant to almost every type of antibiotics, which have included:

Between 2015 and 2020, treatment for gonorrhea typically consisted of azithromycin and ceftriaxone, an injectable type of cephalosporin antibiotic. However, health authorities changed the treatment guidelines in 2020, as the bacteria that cause Neisseria gonorrhoeae were showing increasing resistance to azithromycin.

According to the Centers for Disease Control and Prevention (CDC), ceftriaxone is currently the only antibiotic that is highly effective as a treatment for gonorrhea. However, the CDC also reports a trend of decreasing susceptibility to cephalosporin antibiotics. Gonorrhea has become a “superbug” and is much more difficult to treat than standard gonorrhea in the past.

Gonorrhea may not cause symptoms in some people but can still result in serious health complications without treatment. When symptoms occur, they may present differently in females and males.

Symptoms in females can include:

Symptoms in males can include:

A rectal gonorrhea infection may cause:

The bacteria Neisseria gonorrhoeae causes gonorrhea, which spreads through sexual contact.

A person may get gonorrhea from having vaginal, anal, or oral sex with someone with the infection. A pregnant person with gonorrhea may also pass the infection to their baby during birth, which can lead to eye infections, meningitis, and other newborn complications.

Testing for gonorrhea can involve:

  • a swab of the urethra or cervix
  • a urine sample
  • a throat or rectal swab

A person may also use an at-home testing kit, which involves collecting a sample at home and sending it to a laboratory.

A doctor may diagnose a person with gonorrhea after discussing symptoms or potential exposure to the bacteria that cause the infection and confirming test results.

The CDC recommends doctors treat gonorrhea with a single dose of 500 milligrams of ceftriaxone by injection into the muscle. If a person is unable to take ceftriaxone, a doctor may use an alternative treatment.

People need to follow up for a test of cure to ensure the treatment is effective due to gonorrhea’s increasing drug resistance. They also need to receive another test 3 months after the initial infection, as reinfection is common.

Early diagnosis and treatment can help improve a person’s outcome, as treatment can often stop the infection but cannot repair any permanent damage it causes.

Symptoms should resolve within 2 weeks of treatment. If a person’s symptoms persist, or their follow-up test determines they still have gonorrhea despite treatment, they need to return to their doctor for further treatment.

A doctor will try to determine whether a person has a reinfection after treatment or if the treatment was truly ineffective. If reinfection has occurred, a doctor may repeat treatment with ceftriaxone.

If treatment with ceftriaxone does not work, a doctor may repeat the treatment or consider treatment with other antibiotic drugs, such as gentamicin and azithromycin.

Doctors should follow their health department’s protocol for reporting cases of gonorrhea treatment failure. This includes reporting to the CDC.

Gonorrhea is currently treatable and curable with ceftriaxone. However, the growing resistance of Neisseria gonorrhoeae to antibiotics has made the infection more difficult to treat, and there is a higher risk of gonorrhea becoming untreatable.

Gonorrhea can lead to severe complications without prompt treatment. The infection may spread to the fallopian tubes, which can cause pelvic inflammatory disease (PID), chronic pain, and abscesses in the pelvis. PID can increase the risk of infertility and ectopic pregnancy.

Gonorrhea may also spread to the blood in rare cases, which can lead to a life threatening condition known as disseminated gonococcal infection.

Super gonorrhea refers to the emergence of gonorrhea as a superbug. Neisseria gonorrhoeae, the bacteria that cause the infection, has become increasingly resistant to almost all types of antibiotics that could effectively treat gonorrhea in the past.

Ceftriaxone is currently the only antibiotic that is highly effective as a treatment for gonorrhea. However, the infection may become resistant to this antibiotic over time, as it has with almost every other type in the past.