Atlanta – As reported on, gonorrhea may not seem like a big deal. Aside from HIV, sexually transmitted diseases seem like solved problems, relics of some long-ago time when sex wasn’t discussed and sexual health care was difficult to access. In fact, gonorrhea is surging back, along with its equally forgotten partner, syphilis. In August the Centers for Disease Control said that cases of all STDs have risen for four straight years, to the highest levels in a decade. A sizable portion of that spike is due to gonorrhea, which has become resistant to all the generations of antibiotics that have been used to treat it.

The edifice of STD control that has stood since World War II is crumbling. Funds have been cut, tests are proving inadequate, public health workers are being laid off, and any new compound – such as zoliflodacin (which cures gonorrhea with a single dose but is awaiting phase III trials) – is likely to cost far more than the old antibiotics that have lost their power. One way or another, the era of inexpensive, uncomplicated STD treatment is probably over for good.

STD control is founded on a health care structure that is otherwise unusual in the US: freestanding clinics, often publicly funded, that allowed patients to avoid stigma by seeking care from doctors who may not know them. STDs were so common that inexpensive drugs were paramount.

For decades, this combination of cheap drugs and accessible care worked pretty well – except that gonorrhea, which develops drug resistance quickly, was churning through almost every category of antibiotic used against it: sulfas, penicillin, tetracycline, and then the fluoroquinolone class, leaving just one group, the cephalosporins, still effective. Cases of “super gonorrhea,” resistant to that last two-drug therapy, were identified in the UK in March, and the CDC has been anxiously watching for it in the US since. Zoliflodacin if approved by the FDA will cost a lot more than the antibiotics that are no longer effective. (Wired – Maryn McKenna at

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