"For many years we've had a big problem," says Patricia Campbell.
She is a senior physician and researches gonorrhoea at Akershus University Hospital.
Resistant gonorrhoea has been on the rise globally and in Europe in recent years. Despite this, no new types of antibiotics have reached the market for several decades.
But now the FDA has approved a completely new antibiotic for the sexually transmitted infection: zoliflodacin.
At the same time, another antibiotic, gepotidacin, has also been approved for use against gonorrhoea. It's already used to treat urinary tract infections.
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"It's a bit like waiting for buses. You wait and wait and wait, and then suddenly two come along. That's exciting," says Campbell.
Norway has also seen a sharp rise in cases. 2024 was a record year with 3,150 new confirmed cases.
As infection numbers rise, an increasing number of bacterial strains are developing resistance to antibiotics.
In Europe, resistance to two of the available antibiotics has increased to 65 per cent and 25 per cent respectively in just a few years, according to a study in the scientific journal The Lancet.
Bring infection home from sex tourism
At present, there is really only one type of antibiotic that works for most cases, says Campbell.
In Europe, resistance to this type, called ceftriaxone, is still very low.
The situation is worse in countries like Thailand and the Philippines.
Norwegian heterosexual men who buy sex in these countries bring resistant gonorrhoea back to Norway, Campbell explains.
These bacteria can then spread locally as well.
Patricia Campbell, senior physician at Akershus University Hospital, is working on a PhD on the gonorrhoea bacterium.(Photo: Private)
Can spread deeper into the body
"Sometimes I get calls from distressed doctors about patients who don't improve after treatment," says Patricia Campbell.
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She and her colleagues receive samples of saliva or pus, which they culture in a lab. They then test the bacteria against different antibiotics.
If the patient is lucky, Campbell's team find an antibiotic that kills the bacteria.
But if the bacteria are resistant to everything, doctors have nothing more to offer.
In that case, they can only hope that the infection resolves on its own, Campbell explains.
And that it stays where it started – in the penis, vagina, anus, or throat.
In the worst case, the bacteria spread deeper into the body. This can make a person seriously ill and lead to long-term complications such as chronic pain and infertility.
Tested in clinical trials
That's why the arrival of two new medications is good news.
The study was conducted in Belgium, the Netherlands, South Africa, Thailand, and the United States. The patients had gonorrhoea in the penis or vagina.
Participants were treated with either the new medication or the current standard treatment. The study shows that the new drug was at least as effective as existing options.
In May, another clinical trial published in The Lancet found that the antibiotic gepotidacin, which is already used to treat urinary tract infections, was also effective against gonorrhoea.
Warnings for two reasons
The medications will likely be approved in Norway and Europe within a short time.
Even so, Campbell stresses that neither of the two new antibiotics is a miracle cure. There are some important caveats.
She warns that gonorrhoea could quickly develop resistance to the two new antibiotics.
First, these medications will likely be reserved as last-resort treatments for patients who have not responded to any other antibiotics.
Such strains of gonorrhoea can be especially difficult to eradicate and may also develop resistance to these new drugs.
"If that type then spreads, we have a problem. Because then it's a multi-multi-resistant strain," says Campbell.
Expects reduced disease burden
Second, Campbell believes the way the drugs work may allow bacteria to adapt relatively quickly.
Their mechanism is similar to that of an older antibiotic already in use.
And this particular antibiotic, ciprofloxacin, is the one to which resistance has increased the most.
Rossaphorn Kittiyaowamarn is one of the researchers behind the clinical study showing that the brand new antibiotic works.
"As clinicians, we see the devastating impact drug-resistant gonorrhoea can have on people's lives in Thailand," he tells the Guardian.
He believes the new medication will not only reduce the burden of the disease in the country, but also slow the spread of resistant gonorrhoea to the rest of the world.
