Kamal Ghorui
NEW DELHI: After decades of losing ground to drug resistance, doctors finally have new weapons against gonorrhoea, a common sexually transmitted infection that has steadily outsmarted one antibiotic after another. The recent approval of two new oral medicines by the US Food and Drug Administration has reopened a narrowing treatment window for a disease edging dangerously close to becoming untreatable.The FDA cleared zoliflodacin (Nuzolvence) and gepotidacin (Blujepa) in December 2025 for treating uncomplicated gonorrhoea. Their arrival comes at a critical time, especially for countries like India, where ceftriaxone is the only effective antibiotic left in routine use.“Gonorrhoea is a major STD and resistance is rising fast,” said Dr Kabir Sardana, head of dermatology at Ram Manohar Lohia Hospital. He attributed the trend largely to antibiotic misuse by general practitioners and quacks. “Azithromycin, once a first-line drug, is now largely ineffective because it was prescribed indiscriminately for everything from minor infections to acne,” he said.Experts say the urgency is reflected in global surveillance. Dr Neirita Hazarika, professor and head of dermatology at AIIMS Guwahati, pointed out that the WHO’s 2025 Global Antibiotic Resistance Surveillance Report has classified drug-resistant gonorrhoea as a high-priority pathogen. She said the approval of the two new oral drugs marks a significant milestone, as clinical trials have shown cure rates comparable to current standard therapy. “These drugs expand treatment options for uncomplicated gonorrhoea at a time when resistance to cephalosporins (Ceftriaxone) and macrolides (Azithromycin) is rising,” she said.Ceftriaxone, now the last dependable option in India, is itself under pressure. Widely used for several other infections, it faces a real risk of resistance if misuse continues. “If ceftriaxone fails, we will be left with virtually no antibiotics for gonorrhoea,” Dr Sardana warned.Gonorrhoea affects both men and women and commonly causes urethritis, but untreated infection can lead to infertility, pelvic inflammatory disease and increased HIV risk. With India already carrying a high burden of sexually transmitted infections, doctors warn that failure of existing drugs would have serious public health consequences.The infection has a long history of defeating antibiotics. Sulfa drugs, penicillin, tetracycline, quinolones and cefixime were all abandoned over time as resistance emerged. By 2007, quinolones were dropped entirely due to widespread failure.Experts say the new drugs are promising but require careful use. Prof Seema Sood of AIIMS New Delhi said zoliflodacin and gepotidacin have shown strong activity in studies for uncomplicated urogenital infection.India’s wider antimicrobial resistance crisis adds urgency. ICMR surveillance has flagged rising resistance linked to over-the-counter antibiotic use. Prof Bimal Kumar Das, HOD of microbiology at AIIMS New Delhi, said newer antibiotics are crucial to tackle AMR, while Dr Hitender Gautam noted that early access in India could help curb resistant infections, with gepotidacin showing potential beyond gonorrhoea.
