Drug-resistant STI diagnoses spike in Sydney
Drug-resistant strains of gonorrhea are spreading in NSW as health authorities become increasingly concerned about the declining effectiveness of antibiotics to treat the common sexually transmitted infection.
NSW Health said on Tuesday that 16 cases of multidrug-resistant gonorrhea had been diagnosed so far this year, compared to 41 cases last year.
This includes two cases with high levels of resistance to both first-line treatment (ceftriaxone) and several other drugs, including penicillin. These cases are sometimes called “gonorrhea superbugs” or “super gonorrhea.”
Dr Vicky Sheppeard from NSW Health said most of the cases were in Sydney.
“If drug resistance becomes dominant, we may need to give people intravenous antibiotics…antibiotics may not be available,” Sheppeard said. “So trying to control that right now when the numbers are relatively small is ideal.”
In an alert to doctors earlier this month, NSW Health said the cases, including the latest linked to female sex workers, had mostly occurred in heterosexual people.
Gonorrhea can also occur without symptoms, which means it can spread easily among people who do not know they have the infection. If left untreated, it can cause long-term reproductive problems such as infertility, pelvic inflammatory disease, and complications during pregnancy.
The antibiotic injection ceftriaxone is the recommended first-line treatment against gonorrhea, but since 2014 doctors have been advised to give it along with another antibiotic, azithromycin, because bacteria had begun to show signs of resistance to ceftriaxone alone.
Strains resistant to multiple antibiotics are becoming increasingly common. Drug-resistant gonorrhea was first reported in Australia and the United Kingdom in 2018 and again in 2022.
A report published this week by the Australian Center for Disease Control found community cases increased between 2022 and 2024, coinciding with the easing of COVID-19 travel restrictions.
In 2024, high-level resistance to azithromycin was detected in a record 46 cases. Neisseria gonorrhoeaeCompared to 27 isolated cases in 2023, the report concluded:
Drug-resistant strains of gonorrhea represent a small fraction of the total number of cases recorded each year in Australia, but their ability to rapidly develop resistance to treatment makes them an emerging global health threat.
These types of drug-resistant infections declared a high priority global threat by the World Health Organization.
There have been 1614 reports of gonorrhea in NSW so far this year.
The total number of gonorrhea cases in Australia has doubled over the decade to 44,210 by 2024, according to the Kirby Institute’s latest surveillance data. Men accounted for two-thirds of all notifications.
Associate Professor Tanya Applegate, principal investigator at UNSW’s Kirby Institute center for antimicrobial resistance, said more research was needed into new drugs to combat the ever-changing threat.
The institute is working with the CSIRO on artificial intelligence models that can analyze patterns in the genome sequence of gonorrhea isolates and how they respond to antibiotics.
Angus Thomson is a health reporter for The Sydney Morning Herald.Connect with: X or email.
