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Study: Using antibiotics may make gonorrhoea more dangerous

A new study shows that antibiotic use in the general population can make gonorrhea more difficult to treat and lead to antibiotic resistance.

A gloved hand holds a petri dish covered with bacterial colonies.
“Antibiotic resistance will kill an enormous number of people in 50 years. I want to help prevent that," says Patricia Campbell.
Ava Bosy Ava Bosy Communications adviser
Presented by: Presented by: University of Oslo
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Antibiotic use in the general population may play a role in how quickly gonorrhoea becomes resistance to treatment, according to a new study.

Patricia Campbell is a researcher at the University of Oslo's Department of Clinical Medicine.

She found a clear link between the use of the most common antibiotics in Norway and resistance in gonococci, the bacteria that cause gonorrhoea.

Warns against antibiotic resistance

Campbell, who has a background as a specialist in medical microbiology, warns about resistance.

“Antibiotic resistance is one of the greatest threats facing humanity,” she says.

To detect the threat earlier, Campbell has created a new method for finding antibiotic resistance at the population level.

She believes the way we monitor antibiotic resistance today is part of the problem.

“We only discover the development of resistance after it has already become fact. My approach makes very early warnings possible. The method is also simple and accessible to countries with limited resources,” she says.

Portrait photo of Patricia Campbell.
“Gonorrhoea always finds a way around any antibiotic we use,” says Patricia Campbell.

Sharp increase in gonorrhoea in Norway

Gonorrhoea is a sexually transmitted infection that can infect the urethra, vagina, anus, and throat.

The infection often has no symptoms in the throat and vagina, so many people do not know that they are infected.

Gonococci cause the infection, and this bacterium has the ability to develop antibiotic resistance. Because of this, it is on the World Health Organization's list of priority pathogens.

Except for during the Covid-19 pandemic, Norway has seen a sharp increase in gonorrhoea cases in recent years.

Norwegian antibiotic use 

Campbell's research found that when antibiotic use increased in Norway, antibiotic resistance in gonococci also increased.

She explains that even in a European context where antibiotic use is relatively low, Norwegian antibiotic use appears to increase resistance in gonococci.

Today, there is only have one cure for gonorrhoea: antibiotics.

If the gonococcal bacteria become resistant, the infection may become impossible to cure.

“Gonorrhoea bacteria are what we call fully competent. This means they are able to absorb genetic material directly from other bacteria,” says Campbell.

They build a small tube between themselves and other bacterial cells and use it to send resistance genes to each other.

"This is especially important in the throat and rectum, where there are many bacteria for the gonococci to 'play' with,” the researcher says.

Untreated gonorrhoea can lead to infections in the body

If gonorrhoea goes untreated, it can have serious consequences.

Not only because the infection is contagious, but because it can cause infertility and chronic pain. Untreated gonorrhoea can lead to testicular infection in men and pelvic infection in women.

Babies born to infected mothers can develop serious eye infections that can lead to blindness. In the past, gonorrhoea passed from mother to baby during birth was the most common cause of blindness in the Western world.

Campbell's findings show the importance of controlling antibiotic use at the population level. They also show why monitoring resistance is important to make sure existing treatments continue to work.

Fungi and bacteria don't get along

Antibiotics are sometimes called a 'miracle drug' because they have allowed doctors to treat and cure serious infections that could otherwise be deadly.

If you get a bacterial infection, you will often be given antibiotics. These medicines kill bacteria or stop them from growing. Antibiotics are substances made by living organisms that help keep other organisms away.

Both bacteria and fungi feed on dead material. To keep the food for themselves, they try to poison each other by releasing substances that the other cannot tolerate.

Antibiotics can therefore be very effective against bacterial infections. But they do not work against viruses.

'Good' bacteria must fight for their lives

Why can bacteria that cause gonorrhoea become resistant to antibiotics even if those antibiotics have not previously been used to treat such an infection in that person?

One possible explanation involves the human microbiome. The microbiome is the collection of microorganisms that live both inside and on the outside of our bodies. These are absolutely necessary for our bodies to function properly.

When you treat an infection with antibiotics, most of the bacteria in your body are killed or their growth is inhibited. This also affects the 'good' bacteria.

This creates two problems. We lose some of the body's normal bacteria, while resistant bacteria get a chance to multiply because they have less competition from other bacteria.

“The microbiome bacteria are innocent bystanders, and they must fight for their lives with every antibiotic treatment. Only the most robust survive,” Campbell says.

A domino effect that spreads

Campbell gives an example:

There is a lot of chlamydia in Norway. The treatment for this is typically one week of the antibiotic doxycycline.

“After treatment, the surviving 'good' bacteria in the patient's microbiome will be more resistant to doxycycline. If the patient later gets gonorrhoea, these genes can be transferred directly to the gonorrhoea bacteria from the microbiome,” the researcher explains.

In the worst case, bacteria can become resistant to several types of antibiotics. This is called multi-resistance.

Campbell explains that gonorrhoea is much more difficult to treat in countries like Thailand, because antibiotics can be bought in convenience stores.

"This is actually a big threat to us here in Norway. Among men who buy sex abroad, it's heterosexual men who bring antibiotic-resistant gonorrhoea home,” she says.

Reason to fear a lack of treatment for gonorrhoea in the future

If gonorrhoea becomes resistant to all available antibiotics, the infection can become impossible to treat and cure.

“Gonorrhoea always finds a way around any antibiotic we use. Resistance to one type of antibiotic can create resistance to other types of antibiotics,” says Campbell.

She adds that researchers have found a connection between resistance to the antibiotic ciprofloxacin and resistance to two new antibiotics that will soon become available.

In Norway, resistance to ciprofloxacin is quite common.

“So, unfortunately, I really don't expect any of these new antibiotics to last long, unless we are extremely careful with them,” says Campbell.

Don't take antibiotics unless you must

Campbell's new method could help health authorities take action before resistance becomes widespread.

“My method picks up the very first signs that a bacterial population is heading towards resistance. I hope others can test my method with other types of bacteria,” she says.

She hopes her research will change how antibiotic resistance is monitored.

“Antibiotic resistance will kill an enormous number of people in 50 years. I want to help prevent that,” she says. “Don't take antibiotics unless you absolutely have to. Everything is connected.”

Reference:

Campbell, P. The Influence of National Antibiotic Consumption on Neisseria Gonorrhoeae Antibiotic Resistance in Norway, 2003–2024, The Journal of Infectious Diseases, 2026. DOI: 10.1093/infdis/jiag076.

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