Resistance to the last reliable gonorrhoea drug tripled in five years

**Gonorrhoea is the fourth most reported notifiable infectious disease in
China**, and ceftriaxone is the first-line treatment.

Between 2017 and 2022, resistance to it approximately tripled, with
substantial variation by geographic region.

Why tripling matters more here than elsewhere

For most infections, resistance to one drug means moving to another. Gonorrhoea
has already used up that option:

**Gonorrhea strains were resistant to other antibiotics at prevalences up to
97.6%, varying by antibiotic type.**

Ninety-seven point six per cent. The older drugs are, for practical purposes,
gone — which is exactly how ceftriaxone became the first line, and why its
resistance curve is followed so closely.

Neisseria gonorrhoeae has done this repeatedly, to sulphonamides, penicillin,
tetracyclines and fluoroquinolones in turn. Each time, treatment moved to the
next drug. The list is now short.

Region matters

Resistance varied by geographic region, which is the practically useful
part. It means national treatment guidance can be wrong locally in both
directions — recommending a drug that has stopped working in one province, or
avoiding one that still works elsewhere.

It also means resistance is spreading as clones rather than emerging
independently everywhere, so tracking where they are is the difference between
following the problem and predicting it.

**Emergence and spread of ceftriaxone-resistant clones of N. gonorrhoeae in
China have posed a challenge to gonorrhoea treatment** — a challenge that does
not stay in one country, because the organism travels with people.

Source: Centers for Disease Control and Prevention, MMWR.