A drug-resistant strain of Neisseria gonorrhoeae was recently discovered in Austria

Given the lack of a vaccine to prevent gonorrhoea, disease control requires early detection, effective treatment, and notification of sexual partners. Regrettably, Neisseria gonorrhoeae is now resistant to all antimicrobial classes since the introduction of antimicrobial therapy in the 1930s.

 The current guidelines suggest either ceftriaxone monotherapy or a combination with azithromycin, as first-line therapy. But decreased susceptibility or resistance to both has been noted globally in recent years.

Pleininger et al. describe a recently identified XDR- extensively drug-resistant, Neisseria gonorrhoeae strain with high resistance to azithromycin as well as resistance to cefixime, ceftriaxone, tetracycline, cefotaxime, and ciprofloxacin in their rapid communication.

In April 2022, a male heterosexual patient in Austria developed symptoms after sex without a condom with a Cambodian sex worker. Because no after-treatment gonococcal isolates could be accessible, the authors hypothesize that gonorrhoea treatment with azithromycin and ceftriaxone failed. 

Current treatments and recommendations:

Pleininger et al. claim that the strain discovered in Austria is the second known gonococcal strain that is ceftriaxone resistance and azithromycin resistance and has a close relationship to the “WHO Q” strain. The “WHO Q” reference strain has been linked to three gonorrhoea cases reported in the UK and Australia in 2018, all of which have Southeast Asian connections.

Because of the limited remaining treatment options, extensively drug-resistant and multidrug-resistant Neisseria gonorrhoeae pose a global health concern. Long-term transmission of strains such as those explained by Pleininger et al. may render many gonorrhoea cases incurable.

As a result, the study concludes that “improved antimicrobial resistance monitoring (preferably including cure tests and whole-genome sequencing) is critical, especially in Asia, which has many ceftriaxone-resistant strains; and finally, new antimicrobials for effective gonorrhoea treatment and an effective gonococcal vaccination will be crucial.”