China faces problem of untreatable gonorrhea


In China, there are a growing number of strains of gonorrhea that cannot be treated with antibiotics. Let’s understand this alarming trend

What’s the trend?

According to  the World Health Organization, more than 1 million cases of sexually transmitted infections are reported every day worldwide. The list contains more than 30 different diseases, the main ones being syphilis, chlamydia, gonorrhea, herpes, and HIV. In Europe in 2022, the number of gonorrhea cases increased by 48% compared to the previous year. Such data indicate that the disease is gradually accumulating resistance to drugs. This problem is most pronounced in China.

Gonorrhea is becoming more dangerous

Gonorrhea is an infectious disease that is sexually transmitted. Previously, it was treatable with antibiotics. In the 2020s, health officials warned that gonorrhea was becoming increasingly drug-resistant.

In 2023, two people in the United States were diagnosed with gonorrhea infection with absent or decreased susceptibility to all medications for it. People were cured with injections of one of the drugs in extremely high doses. However, representatives of the US Centers for Disease Control and Prevention (CDC) state: “Right now there is little standing between people and untreatable gonorrhea.”

Danger to China

The frightening trend is confirmed by data from other countries. At the end of March 2024, a study of gonorrhea bacterial isolates (the name given to individual bacteria that were isolated from a common sample for further research) was published . Chinese scientists have found that the disease’s resistance to ceftriaxone, one of the main drugs used to treat it, has increased significantly between 2017 and 2021. In 2022, the number of such strains amounted to about 8% of the 3 thousand collected isolates, compared to 3% in 2017.

The figures may seem small, but compared to other countries they are extremely high. In the US, the prevalence of ceftriaxone-resistant strains between 2017 and 2021 was about 0.2%, in Canada, – 0.6%, in the UK, it was 0.21% in 2022.

Drug resistance

Ceftriaxone is one of the main drugs for treating gonorrhea, since the disease has developed resistance to almost all other drugs over the past few decades: to penicillin and tetracycline in the 1980s, to fluoroquinolones in the 1990s.

By 2007, CDC recommended cephalosporins, but in 2010 the treatment protocol was changed again. CDC officials recommended that doctors combine cephalosporins with other types of antibiotics. But this also turned out to be useless. Since then, ceftriaxone is the last drug used in the United States to treat gonorrhea infections.

Incomplete data

In China, the rapid spread of ceftriaxone-resistant strains is causing extreme concern among doctors. The data were obtained from 2.8 thousand isolates from 13 provinces of the country. This represents 2.9% of all cases reported in China in 2022. Five of the 13 provinces had prevalence rates above 10%, and another three had rates above 25%.

However, the published study has its limitations:

  • the number of reported cases of gonorrhea is likely to be underestimated  – in addition to gaps in reporting, many people with gonorrhea have no symptoms, so they do not seek treatment;
  • The isolates obtained by the researchers accounted for less than 3% of the total number of reported cases, so it is possible that the prevalence rates do not reflect the complete data ;
  • The researchers did not have detailed case data to help identify specific risk factors for the development of resistance.

The need to work together

The study authors note: “The data highlight the need for a comprehensive approach to addressing the problem of antibiotic resistance in gonorrhea in China. We need to identify factors that contribute to such high levels of resistance, especially in provinces where rates exceed 10%.”

The scientists also state that their work is not only an alarming discovery for China, but also an urgent problem for global health. They write: “These resistant strains have spread throughout the world. Collaborative international efforts will be critical to monitoring and mitigating further spread.”


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