Worldwide, drug-resistant gonorrhea is increasing, yet new antibiotics may provide a temporary solution until we face bacterial strains that cannot be treated at all, which heightens the risk of infertility.

Every year, it is estimated that sexually transmitted infections affect over 80 million individuals globally. Gonorrhea infections can spread to various body parts, including the anus, urethra, and genitals. Symptoms often include a burning sensation during urination and unusual discharge from genital areas. Untreated infections can lead to complications such as infertility and miscarriage.

Typically, the treatment for gonorrhea involves ceftriaxone injections, which remain effective against most strains. However, resistance is developing, and the World Health Organization reported that in 2024, about 5 percent of cases in 12 countries, including Thailand, South Africa, and Brazil, showed resistance to ceftriaxone—a sixfold increase since 2022.

When ceftriaxone fails, doctors typically resort to alternative antibiotics. However, it’s only a matter of time before completely untreatable strains appear. “We’re running out of options,” states Alison Luckey from the Global Antibiotic Research and Development Partnership. “It’s been decades since a new treatment for gonorrhea has been approved.”

To combat this escalating issue, researchers found that gepotidacin, an antibiotic pill used for urinary tract infections, can effectively treat gonorrhea, and the U.S. Food and Drug Administration (FDA) is now reviewing the drug for U.S. approval. However, as bacteria evolve resistance to new medications, expanding treatment options is crucial, according to Lackey.

She and her team are currently studying another medication, zoliflodacin, specifically created to combat drug-resistant gonorrhea. In a study, 744 gonorrhea patients from the U.S., South Africa, Thailand, Belgium, and the Netherlands were randomly assigned to receive either zoliflodacin or a combination treatment that includes ceftriaxone and a second antibiotic, azithromycin.

After six days of testing through swabs of participants’ cervixes or urethras, results showed that zoliflodacin effectively cleared roughly 91 percent of infections, while standard treatment had a similar success rate of around 96 percent. Hence, no significant differences were observed between the two treatments, with side effects like headache and nausea being similar and short-lived in both groups.

Most of the 744 tested cases involved strains that were not resistant to ceftriaxone or azithromycin, but prior research indicated that zoliflodacin can effectively target N. gonorrhoeae strains resistant to all standard antibiotics. These findings suggest that zoliflodacin may represent a promising new strategy for treating gonorrhea, both as a first-choice treatment and when traditional options fail, as Lackey observes. “In areas with frequent resistance, early implementation as a primary treatment option could be beneficial,” she adds. Furthermore, since zoliflodacin is administered orally, it may provide a more convenient alternative than ceftriaxone, which some patients avoid due to needle aversion.

Researchers have already submitted findings to the FDA, with a ruling anticipated by December 15, according to Lackey.

If the FDA grants approval, other regions, including the UK, Europe, and Asia, could follow suit shortly, as noted by Charlotte Eve Short from Imperial College London, who was not part of the research.

Alongside ongoing vaccination efforts against gonorrhea, including the recent rollout of the Meningitis Group B vaccine in the UK, the introduction of these two new drugs could signify a pivotal moment in the battle against drug-resistant gonorrhea, according to Short. “This is excellent news,” she states. “While the population-level implications remain uncertain, our dual focus on prevention and treatment should help us significantly reduce resistance rates.”