NEW DELHI: After decades of losing ground due to drug resistance, doctors finally have a new weapon in the fight against gonorrhea, a common sexually transmitted infection that one antibiotic after another has been gradually defeating. The U.S. Food and Drug Administration recently approved two new oral drugs, reopening a narrowing treatment window for a disease that is on the verge of being incurable.The FDA approved zolifludacin (Nuzolvence) and blujepa in December 2025 for the treatment of uncomplicated gonorrhea. Their arrival comes at a critical time, especially for a country like India, where ceftriaxone is the only effective antibiotic in routine use.“Gonorrhea is a major sexually transmitted disease and drug resistance is rising rapidly,” said Dr. Kabir Sadhana, head of the dermatology department at Ram Manohar Lohia Hospital. He attributes this trend mainly to the overuse of antibiotics by GPs and quacks. “Azithromycin was once a first-line drug but is now largely ineffective because it is used indiscriminately to treat everything from minor infections to acne,” he said.Experts say the urgency is reflected in global surveillance. Dr. Neirita Hazarika, Professor and Head of Department of Dermatology, AIIMS Guwahati, pointed out that the World Health Organization’s Global Antimicrobial Resistance Surveillance Report 2025 has listed drug-resistant gonorrhea as a high priority pathogen. She said the approval of the two new oral drugs marked an important milestone as clinical trials showed cure rates comparable to current standard treatments. “These drugs expand treatment options for uncomplicated gonorrhea amid rising resistance to cephalosporins (ceftriaxone) and macrolides (azithromycin),” she said.Ceftriaxone is now the last reliable option in India, but it is also under pressure. It is widely used to treat several other infections and faces a real risk of resistance if misuse continues. “If ceftriaxone fails, we will have few antibiotics left to treat gonorrhea,” Dr. Sadana warned.Gonorrhea affects both men and women, often causing urethritis, but untreated infection can lead to infertility, pelvic inflammatory disease, and an increased risk of HIV. With India already bearing a heavy burden of sexually transmitted infections, doctors warn that failure of existing drugs will have serious public health consequences.This infection has a long history of defeating antibiotics. Over time, sulfonamides, penicillins, tetracyclines, quinolones, and cefixime were all fell into disuse as resistance emerged. By 2007, quinolones were abandoned entirely due to widespread failure.Experts say these new drugs are promising but need to be used with caution. Professor Seema Sood from AIIMS, New Delhi, said that zoliflodacin and geopotidacin have shown strong activity in studies on the treatment of uncomplicated genitourinary tract infections.India’s broader antimicrobial resistance crisis adds to the urgency. ICMR surveillance shows rising resistance associated with over-the-counter antibiotic use. Professor Bimal Kumar Das, head of the department of microbiology at AIIMS, New Delhi, said new antibiotics are crucial to tackle antimicrobial resistance, while Dr Hitender Gautam noted that early use in India could help curb drug-resistant infections, while gepomycin showed potential beyond gonorrhea.
