Enlarge / A billboard from the AIDS Healthcare Foundation is seen on Sunset Boulevard in Hollywood, California, on May 29, 2018, warning of a drug-resistant gonorrhea. (credit: Getty | )

Health officials have long warned that gonorrhea is becoming more and more resistant to all the antibiotic drugs we have to fight it. Last year, the US reached a grim landmark : For the first time, two unrelated people in Massachusetts were found to have gonorrhea infections with complete or reduced susceptibility to every drug in our arsenal, including the frontline drug ceftriaxone. Luckily, they were still able to be cured with high-dose injections of ceftriaxone. But, as the US Centers for Disease Control and Prevention bluntly notes: "Little now stands between us and untreatable gonorrhea."

If public health alarm bells could somehow hit a higher pitch, a study published Thursday from researchers in China would certainly accomplish it. The study surveyed gonorrhea bacterial isolates— Neisseria gonorrhoeae —from around the country and found that the prevalence of ceftriaxone-resistant isolates nearly tripled between 2017 and 2021. Ceftriaxone-resistant strains made up roughly 8 percent of the nearly 3,000 bacterial isolates collected from gonorrhea infections in 2022. That's up from just under 3 percent in 2017. The study appears in the CDC's Morbidity and Mortality Weekly Report.

While those single-digit percentages may seem low, compared to other countries they're extremely high. In the US, for instance, the prevalence of ceftriaxone-resistant strains never went above 0.2 percent between 2017 and 2021 , according to the CDC. In Canada, ceftriaxone-resistance was stable at 0.6 percent between 2017 and 2021. The United Kingdom had a prevalence of 0.21 percent in 2022.

Enlarge / This Scanning Electron Microscope image depicts several clusters of aerobic Gram-negative, non-motile Acinetobacter baumannii bacteria under a magnification of 24,730x. Members of the genus Acinetobacter are nonmotile rods, 1-1.5µm in diameter, and 1.5-2.5µm in length, becoming spherical in shape while in their stationary phase of growth. This bacteria is oxidase-negative and therefore does not utilize oxygen for energy production. They also occur in pairs under magnification. Acinetobacter spp. are widely distributed in nature, and are normal flora on the skin. Some members of the genus are important because they are an emerging cause of hospital acquired pulmonary, i.e., pneumoniae, hemopathic, and wound infections. Because the organism has developed substantial antimicrobial resistance, treatment of infections attributed to A. baumannii has become increasingly difficult. The only drug that works on multi-resistant strains of A.baumannii is colistin which is a very toxic drug.

A new experimental antibiotic can handily knock off one of the world's most notoriously drug-resistant and deadly bacteria —in lab dishes and mice, at least. It does so with a never-before-seen method, cracking open an entirely new class of drugs that could yield more desperately needed new therapies for fighting drug-resistant infections.

The findings appeared this week in a pair of papers published in Nature, which lay out the extensive drug development work conducted by researchers at Harvard University and the Swiss-based pharmaceutical company Roche.

In an accompanying commentary, chemists Morgan Gugger and Paul Hergenrother of the University of Illinois at Urbana-Champaign discussed the findings with optimism, noting that it has been more than 50 years since the Food and Drug Administration has approved a new class of antibiotics against the category of bacteria the drug targets: Gram-negative bacteria. This category—which includes gut pathogens such as E. coli , Salmonella , Shigella , and the bacteria that cause chlamydia, the bubonic plague, gonorrhea, whooping cough, cholera, and typhoid, to name a few—is extraordinarily challenging to kill because it's defined by having a complex membrane structure that blocks most drugs, and it's good at accumulating other drug-resistance strategies

Enlarge (credit: Jacqui VanLiew/Getty Images)

Ella Balasa was 26 when she realized the routine medical treatments that sustained her were no longer working. The slender lab assistant had lived since childhood with the side effects of cystic fibrosis, an inherited disease that turns mucus in the lungs and other organs into a thick, sticky goo that gives pathogens a place to grow. To keep infections under control, she followed a regimen of swallowing and inhaling antibiotics—but by the beginning of 2019, an antibiotic-resistant bacterium lodged in her lungs was making her sicker than she had ever been.

Balasa’s lung function was down to 18 percent. She was feverish and too feeble to lift her arms over her head. Even weeks of intravenous colistin, a brutal last-resort antibiotic, made no dent. With nothing to lose, she asked a lab at Yale University whether she could volunteer to receive the organisms they were researching: viruses that attack bacteria, known as bacteriophages.

Colorized scanning electron micrograph of Neisseria gonorrhoeae bacteria, which causes gonorrhea. (credit: NIAID )

The most highly drug-resistant cases of gonorrhea detected in the US to date appeared in two unrelated people in Massachusetts, state health officials announced Thursday.

The cases mark the first time that US isolates of the gonorrhea-causing bacterium, Neisseria gonorrhoeae , have shown complete resistance or reduced susceptibility to all drugs that are recommended for treatment.

Fortunately, both cases were successfully cured with potent injections of the antibiotic ceftriaxone, despite the bacterial isolates demonstrating reduced susceptibility to the drug. Ceftriaxone is currently the frontline recommended treatment for the sexually transmitted infection.