More than a decade ago, we reported that the world-wide spread of drug-resistant gonorrhea had health authorities very worried. This sexually transmitted infection is caused by a pathogen called Neisseria gonorrhoeae. This bacterium has been evolving quickly to evade the antibiotics used to fight it. For example, in 2010, strains that have become nearly impossible to treat with ordinary antibiotics represented 10 percent of sexually transmitted disease cases. That was more than double the rate in 2009. Rates of sexually transmitted infections are up more than 90% since 2004, although gonorrhea cases have dropped slightly since before the pandemic.
New Antibiotics Against Drug-Resistant Gonorrhea:
The CDC-recommended treatment for gonorrhea is an injection of the antibiotic ceftriaxone. N. gonorrhoeae has developed resistance against antibiotics that were used previously to treat this infection. The specter of resistance to ceftriaxone has been causing nightmares for public health personnel. That is why the recent announcement of an entire new class of antibiotics that work against drug-resistant gonorrhea is so welcome.
FDA Approves Two New Antibiotics:
On December 12, 2025, the FDA announced approval of two new oral medications to treat gonorrhea (FDA News Release, Dec. 12, 2025). One is zoliflodacin (Nuzolvence), which comes as granules to be dissolved in water and swallowed. The other is gepotidacin (Blujepa), provided as tablets. In the trials, these treatments cured more than 90% of the cases, comparable to the standard treatment.
Side Effects of the Antibiotics:
Every medication we know of has some side effects. People in the clinical trial for Nuzolvence reported nausea, diarrhea, headache and dizziness. Lab tests revealed low white blood cell counts, which could make people more vulnerable to other infections while under treatment. Animal studies also indicated there is a possibility of pregnancy loss or male fertility problems for those taking the medicine, so patients should follow precautions. Untreated gonorrhea infections also cause terrible trouble for fertility or for newborn infants, so avoiding treatment is not a good option.
Volunteers who participated in the trial for Blujepa reported side effects of digestive distress, excessive sweating and excessive fatigue. The medications can interact with other drugs, so it is important to make sure the prescriber knows everything the patient is taking.
What If You Don’t Treat Drug-Resistant Gonorrhea?
Women with gonorrhea may not have any symptoms. If they do, though, painful urination, increased vaginal discharge and vaginal bleeding between periods would be the common ones. Men might also experience painful urination or discharge from the penis.
Complications of untreated gonorrhea include infertility, pelvic inflammatory disease, ectopic pregnancies, stillbirths and serious eye infections in newborns. With more than 500,000 cases of gonorrhea in the U.S. each year, FDA’s approval of new antibiotics against this scourge is welcome.
