This man’s journey turned out to be super, in a super gonorrhea-like way. A case report just published in the journal Eurosurveillance described what happened to an Austrian man during and after his trip to Cambodia. And the gist of the story is that this man in his fifties eventually got a new ones extensively resistant (XDR) strain of Neisseria gonorrhoeae†
This is a situation where trying something new is not good. This new strain has high resistance to azithromycin and resistance to ceftriaxone, cefixime, cefotaxime, ciprofloxacin and tetracycline. It is the second such XDR species of N. gonorrhea that has been found, according to the authors of the case report of the Austrian Agency for Health and Food Safety (Sonja Pleininger, Alexander Indra, Florian Heger and Stefanie Schindler), Örebro University (Daniel Golparian, Susanne Jacobsson and Magnus Unemo) and LKH Hochsteiermark (Stefan Heidler ). This isn’t something super to have around, as azithromycin and ceftriaxone are the standard treatments for gonorrhea.
In March 2018 I covered for Forbes what was called the first reported case of N. gonorrhea with both high resistance to azithromycin and resistance to ceftriaxone. At the time, this 2018 case involving a man in the UK was called the ‘worst case of gonorrhea in the world’. Others used the nickname supergonorrhea to describe this bacterium, not because they are faster than a speed bullet, but because such drug resistance makes them particularly difficult to kill.
That man in the UK no longer has to carry the title of ‘worst in the world’ alone. Since then, that XDR N. gonorrhea tribe has continued to spread across different parts of the world because that’s what happens when you don’t do enough to address a problem. And now, based on this new Eurosureville case report, the world apparently has a new second XDR strain on its hands, as well as other naughty parts of the body.
Speaking of naughty, you won’t get super gonorrhea by going to your local hardware store. Remember that gonorrhea is a sexually transmitted infection (STD). That’s why getting super gonorrhea is usually a tip that you’ve had sex at some point, no matter what excuses you tell your partner or steady partner. The man described in the Eurosureville case report not only had sex while traveling in Cambodia, he also had it with a female sex worker without wearing a condom. Yes, condomless sex with a stranger who has had sex with presumably many other partners certainly does not qualify as safe sex. Doing so can be like spinning the STI wheel of unhappiness.
Indeed, about five days after he baked the potato, swept the chimney, set the hot dog on fire, or whatever euphemism you want to use for sex, the man from Austria started experiencing a burning sensation when urinating and discharge from his penis. . Such symptoms are clearly not things that you can just walk away or fix with copious amounts of ice cream and a Netflix binge. That is why the man ended up in a urology department in Austria in April 2022. There, the doctor performed several tests, including a urethral smear, which showed the presence of N. gonorrhea† The doctor then prescribed the man a typical antibiotic treatment for gonorrhea (one gram of ceftriaxone intramuscularly plus 1.5 mg of azithromycin) because the doctor may have thought this was just an ordinary case of gonorrhea.
Unfortunately, that idea about the gonorrhea soon faded. During his follow-up visit to the clinic, about two weeks later, the man reported that his symptoms had disappeared. However, keep in mind that no symptoms do not necessarily mean no infection. A N. gonorrhea infection is not like a mullet. It’s not always obvious when someone has one. Therefore, the doctor performed a repeat smear. A PCR test of what the swab dug up revealed something that wasn’t right. The N. gonorrhea still seemed to hang around, somewhat like a politician who was voted out of office and insists he still holds that position, suggesting the first course of antibiotics hadn’t cured the infection.
Testing this N. gonorrhea strain showed high resistance to azithromycin and resistance to ceftriaxone, cefixime, cefotaxime, ciprofloxacin, and tetracycline, leaving far fewer treatment options. By taking one gram of amoxicillin-clavulanic acid twice a day for seven days, the infection seemed to disappear. However, molecular analysis revealed that the man had a new XDR strain of N. gonorrhoeae. According to the case report, this strain, named AT159, “belongs to the same sublineage as WHO Q”, but differs by 313 DNA sequences. In other words, this test showed that the doctors were dealing with a new strain. And that kids is how this new species the . met Eurosurveillance magazine as a case report.
Of course, case reports have traditionally been reserved for very unusual situations. And even though super gonorrhea is spreading, it’s like hearing people routinely say, “Yeah, have super gonorrhea again,” when you ask them how they’re doing in the hallway. However, this situation may change in the future, perhaps sooner rather than later. At the moment there is no gonococcal vaccine, not nearly enough new antibiotics are being developed and there is a general lack of urgency among politicians, policymakers and companies to tackle the growing problem of antibiotic-resistant bacteria. All of these conditions are great for both strains of super gonorrhea to spread even further and potentially more super gonorrhea strains to show up, which can ultimately make most “regular” cases of gonorrhea really difficult to treat. And all of this could leave the world with a real super problem in the not-so-super-distant future.