• Posted March 28, 2024

Cases of Drug-Resistant Gonorrhea Have Tripled in China, Posing a Global Threat

A strain of highly antibiotic-resistant gonorrhea first emerged in China in 2016, and cases of this tough-to-treat infection have tripled there in just five years, Chinese researchers report.

It's a warning to the rest of the world, they said.

Strains resistant to the first-line treatment ceftriaxone (and many other antibiotics) "have spread internationally and collaborative cross-border efforts will be essential to monitoring and mitigating its further spread," wrote a team led by Dr. Shao-Chun Chen, of the Chinese Academy of Medical Sciences in Nanjing.

A single intramuscular injection of ceftriaxone is the recommended first treatment for gonorrhea in both China and the United States.

Cases of ceftriaxone-resistant strain of gonorrhea are still very rare in the United States, hovering around 0.2% of cases between 2016 and 2020, according to the U.S. Centers for Disease Control and Prevention.

But that could change. According to the latest data, by 2022 the prevalence in China of infections with Neisseria gonorrhoeae resistant to ceftriaxone "was 8.1% [of cases], approximately three times the 2017 rate of 2.9%," the new study found.

In such cases, turning to other antibiotics may be of little use. The Chinese team found that "gonorrhea strains were resistant to other antibiotics at prevalences up to 97.6%, varying by antibiotic type."

The new data comes from surveillance of trends for drug-resistant cases of gonorrhea in 13 different Chinese provinces from 2017 through 2022. Resistant strains were more prevalent in some provinces than others, the researchers noted.

There are more than 82 million new gonorrhea cases worldwide each year, according to the World Health Organization (WHO). According to the CDC, cases surged to more than 710,000 in 2021 in the United States, a 28% increase from 2017.

According to Chen's team, it will be essential to determine factors that might be encouraging the emergence and spread of drug-resistant strains of gonorrhea, including the overuse of antibiotics, which can spur dangerous viral mutations.

The findings were published March 28 in the CDC journal Morbidity and Mortality Weekly Report.

Illness and infertility

The symptoms of gonorrhea can vary, depending on the individual and the severity of the infection. According to the CDC, many people with gonorrhea have no symptoms or very mild symptoms that go unnoticed or are mistaken for another infection.

Importantly, women often don't have obvious symptoms, while men typically do.

Untreated gonorrhea in women can lead to long-term and serious complications such as pelvic inflammatory disease (PID), which can cause infertility, chronic abdominal pain and scarring of the uterus or fallopian tubes.

However, according to the CDC, these are gonorrhea symptoms in women:

• White or yellow vaginal gonorrhea discharge that can be accompanied by a strong odor

• Pain or burning during urination

• Abdominal or pelvic pain

• Bleeding between periods

In contrast to women, men will almost always experience symptoms and usually seek testing right away.

The CDC says these are gonorrhea symptoms in men:

• Painful urination

• Discharge from the penis -- usually white, yellow or green in color. It can be thick or thin

• Swollen or painful testicles

• Fever

In men, left untreated, gonorrhea can cause inflammation in the tubes leading to the testicles, causing infertility. The American Sexual Health Association also reports inflammation of the prostate and scarring of the urethra as symptoms of untreated gonorrhea in men.

More information

Find out more about gonorrhea at the Mayo Clinic.

SOURCE: Morbidity and Mortality Weekly Report, March 28, 2024