The emergence of new treatments for gonorrhea marks a potentially pivotal moment in the battle against the increasingly resistant strains of the bacteria, according to researchers. For the first time in decades, novel medications are poised to make a significant impact on controlling this rising health threat.

Across the globe, gonorrhea is surging, with over 82 million new cases each year. The situation is especially dire in Africa and the World Health Organization’s (WHO) Western Pacific region, which spans from Mongolia and China to New Zealand. Alarmingly, England is seeing unprecedented infection rates, while Europe has experienced a threefold increase in cases since 2014.

This spike is compounded by the growing menace of drug-resistant strains, prompting the WHO to classify it as a “priority pathogen.” A WHO-led surveillance initiative has revealed that resistance to the primary antibiotics, ceftriaxone and cefixime, has escalated sharply, with rates climbing from 0.8% to 5% and from 1.7% to 11% between 2022 and 2024, respectively.

Among the newly approved therapies is Zoliflodacin, which signifies hope for managing this sexually transmitted infection. Within the past week, two such treatments have gained regulatory approval, marking a significant advancement in medical options.

Dr. Tereza Kasaeva, who heads the WHO’s sexually transmitted infections department, emphasized the crucial timing of these approvals. “The approval of new treatments for gonorrhea,” she stated, “is an important and timely development in the context of rising global incidence, increasing antimicrobial resistance, and the very limited therapeutic options currently available.”

Zoliflodacin, marketed under the brand name Nuzolvence, received the nod from the U.S. Food and Drug Administration on December 12 for treating gonorrhea, an infection with potentially severe health repercussions, including infertility. Experts are optimistic that this targeted treatment approach will help decelerate the progression of resistance.

Gepotidacin, an antibiotic developed by the pharmaceutical company GSK that is also used to treat urinary tract infections, was also approved on 11 December after it was shown in trials to work against drug-resistant strains of gonorrhoea.

Zoliflodacin emerged from a new, not-for-profit approach for antibiotic development, in which the non-profit organisation Global Antibiotic Research & Development Partnership (GARDP) collaborated with the pharmaceutical company Innoviva.

Dr Manica Balasegaram, executive director of GARDP, said: “This approval marks a huge turning point in the treatment of multidrug-resistant gonorrhoea, which until now has been outpacing antibiotic development.”

In results published in the Lancet last week, zoliflodacin cured more than 90% of genital gonorrhoea infections, putting it on an equal footing with current standard treatment, which combines two antibiotics: an injection of ceftriaxone followed by an oral dose of azithromycin. No serious safety issues were reported.

The trial of the drug, which is part of a new class of antibiotics called spiropyrimidinetriones, involved 930 participants from Belgium, the Netherlands, South Africa, Thailand and the US.

Under the terms of its partnership, GARDP has the right to register and commercialise it in all low-income countries, most middle-income countries, and several high-income countries.

Dr Rossaphorn Kittiyaowamarn, principal investigator of the trial in Thailand, said: “As clinicians, we see the devastating impact drug-resistant gonorrhoea can have on people’s lives in Thailand.

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.”