Roger-Luc Chayer (Image : Nuzolvence)
Resistance of Gonorrhea to Antibiotics: A Growing Global Concern
For several years, significant resistance of gonorrhea to most antibiotics traditionally used to treat this widespread sexually transmitted infection has been observed worldwide.
What is antibiotic resistance?
Resistance of gonorrhea to antibiotics does not cause specific symptoms different from those of a “classic” infection, which is one of the main clinical challenges. In practice, it mainly manifests as persistence or recurrence of symptoms despite a properly prescribed and followed treatment.
A person may continue to experience urethral discharge, burning during urination, pelvic or testicular pain, abnormal bleeding, or pain in the rectum and throat when these sites are infected, even though these symptoms should normally disappear a few days after starting treatment.
Possible complications of resistant gonorrhea
In some cases, symptoms can worsen or evolve into serious complications such as increased inflammation of the genital organs or epididymitis (infection of the tubes around the testicles) in men, indicating failure of the initial treatment.
It also happens that the infection remains asymptomatic while persisting, which promotes transmission and delays the diagnosis of resistance. That is why, when symptoms do not improve or quickly reappear after treatment, doctors suspect possible resistance, perform cultures with antibiotic sensitivity testing when possible, and adjust the management accordingly.
Resistant gonorrhea and the risk of sepsis
Unfortunately, gonorrhea resistance can also progress to sepsis. Resistant gonorrhea can persist in the body when treatment is ineffective, allowing the bacteria to multiply and spread. In some cases, the infection may develop into disseminated gonococcal infection, an invasive form where the bacteria enter the bloodstream. This dissemination can cause bacteremia, commonly associated with sepsis, with systemic symptoms such as fever, chills, severe joint pain, skin lesions, or infectious joint involvement.
Strict sepsis, meaning a potentially severe generalized inflammatory response linked to the presence of bacteria in the blood, remains rare but is a recognized complication when gonorrhea is not effectively treated.
The ongoing search for new agents to overcome resistance
For over forty years, medical laboratories, supported by numerous government grants and university research centers, have been trying to find a solution to antibiotic resistance, even as gonorrhea cases multiply each year, reaching record levels, especially among younger populations.
This sharp increase results from two concurrent factors: decreased protective practices and refusal to use condoms, combined with the spread of resistant and often asymptomatic gonorrhea strains.
Introducing zoliflodacin
Zoliflodacin is a new antibiotic under development specifically designed to treat resistant gonorrhea, including strains that have become resistant to conventional treatments. It works by blocking a mechanism essential for the survival of the bacteria responsible for gonorrhea, preventing it from multiplying and allowing the body to eliminate it. Its mode of action differs from currently used antibiotics, which explains the interest it generates amid rising resistance.
This antibiotic has been evaluated in clinical studies showing promising results, particularly for genital and rectal infections, with the potential advantage of oral administration.
Zoliflodacin and Health Canada’s recommendations
Although zoliflodacin has just been approved in the United States and Europe, it is not yet approved in Canada. The drug is currently under review by Health Canada, which is expected to make a decision consistent with other regulatory authorities in the coming months.
Meanwhile, Health Canada continues to recommend regular screening, ideally every three months for sexually active individuals, the use of condoms during all sexual activities, including oral sex with or without penetration—even for simple friction—and prompt treatment at the first appearance of symptoms.
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