An Austrian man in his fifties has been infected with a super potent strain of gonorrhea that can’t be treated with common antibiotics after having an unprotected sexual encounter during a trip to Cambodia.
The case, documented in the peer-reviewed medical journal Eurosurveillance last week, was described by the researchers to be a “concern for future treatment of gonorrhea” and a “major global public health threat.”
In April, five days after having unprotected sex with a sex worker in Cambodia, the man was seen by a urologist in Austria complaining of painful urination and discharge flowing out the tip of his penis. Diagnosed with gonorrhea, he was initially prescribed regular antibiotics.
His symptoms alleviated two weeks later, and swab culture tests on his samples returned negative, but a PCR test done on his urethral sample showed that he was still positive for gonorrhea—a result doctors considered a “possible treatment failure”.
After seven days of taking amoxicillin-clavulanic acid, another antibiotic treatment for gonorrhea, the man’s urethral sample again returned negative in a culture test. He did not receive a PCR test the second time. Scientists concluded, however, that the gonorrhea strain was highly resistant to common antibiotics ceftriaxone and azithromycin.
In 2018, the first such case of super gonorrhea—dubbed the WHO Q strain—was identified in the United Kingdom, shortly followed by two more cases in Australia. All of these cases also had links to Southeast Asia, the Eurosurveillance report noted.
“If such strains manage to establish a sustained transmission, many gonorrhea cases might become untreatable,” the authors said.
If left untreated, gonorrhea—including asymptomatic cases—can result in infertility and an increased risk of HIV. Symptoms in men typically include painful urination, swelling in one testicle, and a pus-like discharge from the penis or rectum. Symptoms in women include a painful sensation when peeing, increased vaginal discharge and bleeding between periods.
Gonorrhea, which is caused by the bacteria Neisseria gonorrhoeae, is the second most common sexually transmitted infection worldwide after chlamydia. The World Health Organization estimates that 82 million people were infected with gonorrhea in 2020, with antimicrobial resistance an increasing cause for concern.
According to the WHO, gonorrhea developed antimicrobial resistance at the beginning of the 20th century. “Resistance has continued to expand since then,” it said, citing increased resistance of gonorrhea to “last line” antibiotics such as cefixime and ceftriaxone.
Experts worry that the rise of such cases might render current treatment ineffective, potentially resulting in a sexually transmitted global epidemic.
“The [gonorrhoeae] microbe appears to be emerging as a superbug,” Dr. Magnus Unemo, the head of the World Health Organization’s Collaborating Center for Gonorrhea and Other Sexually Transmitted Infections in Sweden, told the New Yorker as far back as 2012. “This is what we have feared for many years.”
The Cambodian sex worker believed to also be carrying gonorrhea has not been identified. Ann Chhorn, project manager at Cambodian Women for Peace and Development, an NGO working with sex workers, said that despite Cambodia’s success in bringing down HIV rates, once the highest in Asia, access to contraceptives remains an issue.
“With the COVID-19 outbreak, we found that sex workers [have difficulties accessing] healthcare,” he told VICE World News. “We [also] found that female entertainment workers can’t access condoms.”
There are an estimated 70,000 known female entertainment workers in the country as of 2019, including sex workers and those who work in entertainment venues like massage parlors and karaoke lounges. These women often come from poor families, and migrate to urban areas for work.