Health authorities have heralded a potential breakthrough in the global battle against drug-resistant gonorrhoea, following the approval of the first new treatments for the sexually transmitted infection in decades.
A Global Health Crisis Intensifies
The announcement comes amid surging infection rates and growing antimicrobial resistance worldwide. More than 82 million new gonorrhoea infections occur globally each year, with particularly high rates in Africa and the World Health Organization's Western Pacific region. In Europe, cases in 2023 were three times higher than in 2014, while England is currently experiencing record-high numbers.
The situation is exacerbated by the bacteria's increasing resistance to existing antibiotics. The WHO, which has designated gonorrhoea a "priority pathogen", found that resistance to the primary drugs ceftriaxone and cefixime rose sharply between 2022 and 2024, jumping from 0.8% to 5% and from 1.7% to 11% respectively.
Two New Weapons in the Arsenal
In a significant development last week, the US Food and Drug Administration (FDA) approved two new antibiotics for use against the infection, which can cause serious complications including infertility.
The first, zoliflodacin (brand name Nuzolvence), was approved on 12 December. It represents a novel approach to antibiotic development, emerging from a not-for-profit collaboration between the Global Antibiotic Research & Development Partnership (GARDP) and the pharmaceutical company Innoviva. According to trial results published in the Lancet, the single-dose oral treatment cured more than 90% of genital gonorrhoea infections, matching the efficacy of the current standard dual-therapy.
Dr Manica Balasegaram, executive director of GARDP, stated: "This approval marks a huge turning point in the treatment of multidrug-resistant gonorrhoea, which until now has been outpacing antibiotic development."
The second drug, gepotidacin, developed by GSK, received FDA approval on 11 December. This antibiotic, also used for urinary tract infections, has shown effectiveness against drug-resistant gonorrhoea strains in clinical trials.
Hope for Future Control and Access
Researchers hope the targeted use of these new drugs will help slow the development of further resistance. The zoliflodacin trial involved 930 participants across five countries: Belgium, the Netherlands, South Africa, Thailand, and the United States. Under its unique development partnership, GARDP holds the rights to register and commercialise the drug in low-income countries, most middle-income nations, and several high-income countries, aiming to ensure broad access.
Dr Tereza Kasaeva, director of the WHO's sexually transmitted infections department, emphasised the importance of the development: "The approval of new treatments for gonorrhoea is an important and timely development in the context of rising global incidence, increasing antimicrobial resistance and the very limited therapeutic options currently available."
Clinicians on the frontline welcomed the news. Dr Rossaphorn Kittiyaowamarn, principal investigator of the trial in Thailand, said: "Having a single-dose, oral treatment like this will be a game-changer for gonorrhoea control. This is essential to reduce the burden of disease for individuals and to prevent the spread of highly drug-resistant gonorrhoea globally."
While these approvals offer renewed hope, health officials continue to stress the importance of prevention, testing, and responsible antibiotic use to curb the ongoing public health threat posed by antimicrobial resistance.
