In the race to outsmart "untreatable" antibiotic-resistant gonorrhea, one of the three new treatments on the track is about to enter Phase 3 clinical trials. Hopefully, it'll be widely accessible sooner rather than later, for the 78 million people who are diagnosed with gonorrhea each year.
Drug-resistant gonorrhea made headlines last week, earning the moniker "super gonorrhea" with its ability to outlast most treatments.
The bacteria Neisseria gonorrhea, a quickly-adapting pathogen, causes gonorrhea. It can often be transmitted orally, in which case the symptoms are easily mistaken for a non-STD-related sore throat (which delays diagnosis and treatment). The more obvious symptoms include genital pain, discharge, and sometimes itching. And for any mode of transmission, many cases are asymptomatic.
If left untreated, even without noticeable symptoms, gonorrhea can cause serious complications. Those include pelvic inflammatory disease (which may cause pain, fever, ectopic pregnancy, and infertility), and epididymitis (which may cause infertility). In rare cases it can lead to disseminated gonococcal infection, which can be fatal; the infection spreads to the blood and causes tenosynovitis (inflammation of the sheath around a tendon), arthritis, and dermatitis (a skin rash).
It's not just one treatment gonorrhea has learned to fight. It's a whole series of antibiotics, right up to the last-resort treatment, extended-spectrum cephalosporins (ESCs). These drugs are meant to be used when all else fails, which has delayed the evolution of resistance to them. A few days ago, the WHO reported that there have already been cases — in 66% of 77 surveyed countries — where ESCs are ineffective. That means potentially incurable gonorrhea. No wonder they're calling it "super."
The WHO has updated global recommendations as a result of the findings, advising the use of both ceftriaxone (an ESC) and azithromycin (another antibiotic) together. ESCs still mostly work — but perhaps only for now. New treatments will be needed even more in the future, as Neisseria gonorrheafinds more ways to beat the current drugs.
Luckily for all of us (and our sex lives), there's a new drug nearing final clinical trials. Zoliflodacin is a new antibiotic to fight super gonorrhea, and it's getting closer to public availability. It is being made and tested by Entasis Therapeutics and the Global Antibiotic Research and Development Partnership (a nonprofit organization). On Friday, June 7, they announced plans to enter Phase 3 global clinical trials (a larger and more long-term study to test and improve it) soon. After that, it could go through Phase 4 trials and if successful, could be distributed throughout the many countries where it may be needed. Zoliflodacin is the first antibiotic in its class — no other antibiotics use the same mechanism it does — which means it'll likely be harder for gonorrhea to develop resistance to this drug.
Sometimes the body can get rid of gonorrhea on its own just given time, but the pathogen can do a lot of damage if left untreated. It is known to cause ectopic pregnancies, pelvic inflammatory disease, infertility, and pelvic or abdominal pain. In some rare and especially dangerous cases, it can spread to the blood or joints if left untreated. And beyond the effects of gonorrhea itself, it can increase susceptibility to other STDs like HIV.
Risk can be reduced by using protection (condoms or dental dams), getting tested for STDs regularly if you are sexually active, and asking your partner or partners to get tested regularly. You can contract gonorrhea from any unprotected oral, vaginal, or anal sex.
Zoliflodacin has been given "fast track" status by the FDA, through its placement in a category that speeds regulatory review and also allows those making it longer exclusive rights to the antibiotic's production. That designation will ideally help Zoliflodacin reach patients as soon as possible, to stop "super" gonorrhea from becoming a common problem.