New antibiotic could stave off drug-resistant gonorrhoea
Neisseria gonorrhoeae, the microbe responsible for gonorrhoea, is developing resistance to most antibiotics, which means we need new drugs to treat the condition. An antibiotic called zoliflodacin might be part of a solution
Neisseria gonorrhoeae bacteria
J Marshall/Tribaleye Images / Alamy
Drug-resistant gonorrhoea is on the rise worldwide, but a new antibiotic could buy us more time before the emergence of completely untreatable strains of the bacteria, which is known to potentially raise the risk of infertility.
The sexually transmitted infection is estimated to affect more than 80 million people worldwide annually. It occurs when the bacterium Neisseria gonorrhoeae infects various body parts, including the anus, urethra and genitals. Common symptoms include a burning sensation when urinating and unusual discharge from the vagina or penis. If left untreated, it can cause infertility and pregnancy loss.
The disease is usually treated with injectable ceftriaxone, the last antibiotic that works against most N. gonorrhoeae strains – but the bacterium is evolving resistance to this drug too. For instance, the World Health Organization found that, across 12 countries including Thailand, South Africa and Brazil, about 5 per cent of cases were ceftriaxone-resistant in 2024 – a sixfold increase since 2022.
If ceftriaxone fails, doctors usually turn to other antibiotics, but it’s only a matter of time until completely untreatable strains evolve. “We are running out of options,” says Alison Luckey at the Global Antibiotic Research and Development Partnership. “It’s been decades since a gonorrhoea drug has been approved.”
Attempting to stall this growing threat, researchers previously found that gepotidacin, an antibiotic pill used against urinary tract infections, can effectively treat gonorrhoea, with the US Food and Drug Administration (FDA) expected to make an approval decision on using the drug in the US today. But since bacteria usually evolve resistance to new drugs, the more treatment options we have, the better, says Luckey.
She and her colleagues have now tested another drug, zoliflodacin, which was specifically developed to treat drug-resistant gonorrhoea. The researchers randomly assigned 744 people with gonorrhoea – from the US, South Africa, Thailand, Belgium and the Netherlands – to take either zoliflodacin, or a combination treatment involving ceftriaxone and another antibiotic called azithromycin.