Drug-resistant gonorrhoea is on the rise worldwide, but a new antibiotic could buy us more time before the emergence of completely untreatable strains of the bacteria, which is known to potentially raise the risk of infertility.

The sexually transmitted infection is estimated to affect annually. It occurs when the bacterium Neisseria gonorrhoeae infects various body parts, including the anus, urethra and genitals. Common symptoms include a burning sensation when urinating and unusual discharge from the vagina or penis. If left untreated, it can cause infertility and pregnancy loss.

The disease is usually treated with injectable ceftriaxone, the last antibiotic that works against most N. gonorrhoeae strains – but the bacterium is evolving resistance to this drug too. For instance, the World Health Organization found that, across 12 countries including Thailand, South Africa and Brazil, about 5 per cent of cases were ceftriaxone-resistant in 2024 – .

If ceftriaxone fails, doctors usually turn to other antibiotics, but it’s only a matter of time until completely untreatable strains evolve. “We are running out of options,” says at the Global Antibiotic Research and Development Partnership. “It’s been decades since a gonorrhoea drug has been approved.”

Attempting to stall this growing threat, researchers previously found that gepotidacin, an antibiotic pill used against urinary tract infections, can effectively treat gonorrhoea, with the US Food and Drug Administration (FDA) expected to make an . But since bacteria usually evolve resistance to new drugs, the more treatment options we have, the better, says Luckey.

She and her colleagues have now tested another drug, zoliflodacin, which was specifically developed to treat drug-resistant gonorrhoea. The researchers randomly assigned 744 people with gonorrhoea – from the US, South Africa, Thailand, Belgium and the Netherlands – to take either zoliflodacin, or a combination treatment involving ceftriaxone and another antibiotic called azithromycin.

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By swabbing participants’ cervix or urethra six days later, on average, the researchers found that zoliflodacin had cleared about 91 per cent of the infections, while the equivalent figure was 96 per cent among those who received standard treatments. This means there was no significant difference between the treatments. Side effects, such as headache and nausea, were similar and transient in both groups.

The vast majority of the 744 cases were caused by strains that weren’t resistant to ceftriaxone or azithromycin. But a prior study showed that, in a lab dish, . As such, the results add to evidence that zoliflodacin could offer a fresh approach against gonorrhoea, not just as a first-line treatment but potentially when standard drugs fail, says Luckey. “In places where you’re looking at frequent risk of resistance, there may be a greater appetite to use it sooner as a first-line treatment,” she says. What’s more, the drug – which is taken orally – could offer a more convenient way to treat gonorrhoea than ceftriaxone, which some people avoid due to a fear of needles, she says.

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The researchers have already submitted their data to the FDA, which is expected to make an approval decision on 15 December, says Luckey.

If this is positive, approvals elsewhere, including in the UK, Europe and Asia, will probably follow soon after, says at Imperial College London, who wasn’t involved in the study.

Together with ongoing efforts to vaccinate against gonorrhoea, with the , gaining two new drugs could mark a turning point in the fight against drug-resistant gonorrhoea, says Short. “This is great news,” she says. “We have yet to see on a population level what this could mean, but if we’re coming at it from two different directions – we’ve got prevention and we’ve got treatment – we should be able to make a bigger impact on reducing resistance.”

Surgery is typically a last resort for people with a chronically blocked or runny nose. But in some cases, it may actually work better than the antibiotics that are routinely prescribed to treat the condition.

Chronic sinusitis affects about and occurs when the mucus-producing cavities – sinuses – around the nose become inflamed. Common symptoms include a blocked or runny nose, a reduced sense of smell and facial pain, with these persisting for more than 12 weeks. The cause of the condition is usually unclear but may involve viral infections or a change to the nose microbiome.

The first line of treatment involves anti-inflammatory nasal sprays and flushing saline solution through the nose daily. But if symptoms persist, doctors often prescribe a three-month course of the antibiotic clarithromycin. This is used for its anti-inflammatory properties rather than its bacteria-killing properties, says at the University of East Anglia in the UK.

As a last resort, people can undergo surgery to widen the sinuses and remove any benign nasal growths, or polyps, which form and worsen symptoms in of cases. Yet no prior study has directly compared surgery with antibiotics.

To fill this gap, Philpott and his colleagues recruited more than 500 adults with chronic rhinosinusitis. In surveys, the participants rated the severity of 22 symptoms, such as facial pain and how runny their nose was, with an average score of 55 out of 110.

The team then randomly assigned the participants to take either a three-month course of clarithromycin, placebo pills or undergo nasal surgery. All the participants also used nasal sprays and rinsed their noses with saline.

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Six months later, those who took either clarithromycin or placebo pills reported a roughly 10-point reduction in the severity of their symptoms compared with before the treatment, a level that would noticeably improve their quality of life, says team member at King’s College London. But since the effect was seen in both the antibiotic and placebo groups, it was probably due to the nasal sprays and rinsing, she says.

Those in the surgery group saw a roughly 30-point improvement in their symptoms compared with before surgery, suggesting doctors should offer this instead of antibiotics, says Hopkins.

There is an important caveat, however. About 80 per cent of the participants had nasal polyps, possibly because the study took place during the covid-19 pandemic, and catching the coronavirus may trigger the , says Hopkins. Further studies are needed to check whether the results apply to those without polyps, who we know harbour different types of inflammation, she says.

Gonorrhoea is resistant to nearly all antibiotics, but one commonly used for urinary tract infections (UTIs) may be able to treat drug-resistant cases.

The sexually transmitted infection (STI) is caused by Neisseria gonorrhoeae, a bacterium that can infect various parts of the body, including the genitals and urethra. Common symptoms include a burning pain when urinating and discharge from the vagina or penis. If left untreated, the infection can raise the risk of infertility and premature birth.

Standard treatment involves an injection of ceftriaxone, the last antibiotic that works against most N. gonorrhoeae strains, but some have evolved to resist this drug too, . “We know drug-resistant strains will spread elsewhere. In fact, we’ve already seen this with cases in North America and Europe that were imported from Asia,” says at the University of Toronto in Canada, who wasn’t involved in the study.

If ceftriaxone doesn’t work, the , but it is only a matter of time before completely untreatable strains emerge, as bacteria are constantly evolving to evade antibiotics, says Allen.

In an attempt to buy some time, at pharmaceutical company GlaxoSmithKline in Pennsylvania and her colleagues looked at around 400 people with N. gonorrhoeae infections in their genitals and urinary tracts. About half were randomly assigned to take two oral doses of the antibiotic gepotidacin. , this isn’t recommended to treat gonorrhoea, but .

The remaining participants received a single injection of ceftriaxone plus one oral dose of azithromycin, which belongs to a different antibiotic class. Although taking these at the same time isn’t recommended by the WHO, combining azithromycin with the first-line treatment ceftriaxone sets a higher bar with which to compare gepotidacin against, says Allen.

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Between four and eight days later, the researchers analysed swabs from 370 of the participants, with the remaining ones having dropped out or returning poor quality samples. The team found that both treatment regimens cleared all of the participants’ infections.

“It’s incredibly promising,” says Allen. “It shows a new treatment that’s highly effective and is very much easier to administer than the current antibiotic that’s given as a shot in the arm or the buttocks.”

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Although the study didn’t include people with ceftriaxone-resistant strains of infection, gepotidacin works by preventing N. gonorrhoeae from replicating its DNA, while ceftriaxone destroys the bacterium’s rigid outer layer. These different mechanisms of action may mean that strains with mutations that enable them to resist ceftriaxone shouldn’t yet be able to resist gepotidacin, says Allen.

Still, if gepotidacin became widely used, N. gonorrhoeae would probably eventually evolve resistance to it too, so it is important to tackle the STI in other ways, such as by developing a vaccine that prevents infections, says Allen. What’s more, checking what strains people carry before prescribing antibiotics could reduce the inappropriate use of such drugs, which can worsen resistance rates, she says.