Drug-resistant gonorrhoea is on the rise worldwide, but a new antibiotic could buy us more time before the emergence of completely untreatable strains of the bacteria, which is known to potentially raise the risk of infertility.

The sexually transmitted infection is estimated to affect annually. It occurs when the bacterium Neisseria gonorrhoeae infects various body parts, including the anus, urethra and genitals. Common symptoms include a burning sensation when urinating and unusual discharge from the vagina or penis. If left untreated, it can cause infertility and pregnancy loss.

The disease is usually treated with injectable ceftriaxone, the last antibiotic that works against most N. gonorrhoeae strains – but the bacterium is evolving resistance to this drug too. For instance, the World 91ɫ��Ƭ Organization found that, across 12 countries including Thailand, South Africa and Brazil, about 5 per cent of cases were ceftriaxone-resistant in 2024 – .

If ceftriaxone fails, doctors usually turn to other antibiotics, but it’s only a matter of time until completely untreatable strains evolve. “We are running out of options,” says at the Global Antibiotic Research and Development Partnership. “It’s been decades since a gonorrhoea drug has been approved.”

Attempting to stall this growing threat, researchers previously found that gepotidacin, an antibiotic pill used against urinary tract infections, can effectively treat gonorrhoea, with the US Food and Drug Administration (FDA) expected to make an . But since bacteria usually evolve resistance to new drugs, the more treatment options we have, the better, says Luckey.

She and her colleagues have now tested another drug, zoliflodacin, which was specifically developed to treat drug-resistant gonorrhoea. The researchers randomly assigned 744 people with gonorrhoea – from the US, South Africa, Thailand, Belgium and the Netherlands – to take either zoliflodacin, or a combination treatment involving ceftriaxone and another antibiotic called azithromycin.

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By swabbing participants’ cervix or urethra six days later, on average, the researchers found that zoliflodacin had cleared about 91 per cent of the infections, while the equivalent figure was 96 per cent among those who received standard treatments. This means there was no significant difference between the treatments. Side effects, such as headache and nausea, were similar and transient in both groups.

The vast majority of the 744 cases were caused by strains that weren’t resistant to ceftriaxone or azithromycin. But a prior study showed that, in a lab dish, . As such, the results add to evidence that zoliflodacin could offer a fresh approach against gonorrhoea, not just as a first-line treatment but potentially when standard drugs fail, says Luckey. “In places where you’re looking at frequent risk of resistance, there may be a greater appetite to use it sooner as a first-line treatment,” she says. What’s more, the drug – which is taken orally – could offer a more convenient way to treat gonorrhoea than ceftriaxone, which some people avoid due to a fear of needles, she says.

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The researchers have already submitted their data to the FDA, which is expected to make an approval decision on 15 December, says Luckey.

If this is positive, approvals elsewhere, including in the UK, Europe and Asia, will probably follow soon after, says at Imperial College London, who wasn’t involved in the study.

Together with ongoing efforts to vaccinate against gonorrhoea, with the , gaining two new drugs could mark a turning point in the fight against drug-resistant gonorrhoea, says Short. “This is great news,” she says. “We have yet to see on a population level what this could mean, but if we’re coming at it from two different directions – we’ve got prevention and we’ve got treatment – we should be able to make a bigger impact on reducing resistance.”

A wild, turkey-like bird tends to eat more toxic plants during the breeding season, possibly as medicine to fend off sexually transmitted diseases and so appear more attractive to potential mates.

Male great bustards (Otis tarda), the heaviest flying animals alive today, expend great energy in elaborate feather displays to attract females. They also present their cloaca – the common opening for their digestive, urinary and reproductive tracts – to females, who appear to “examine” the orifice and even peck at it, possibly looking for signs of infection.

Only around 10 per cent of males successfully mate, so they might benefit from self-medicating prior to these examinations, says at the Spanish National Research Council in Madrid.

In previous research, Bautista-Sopelana and his colleagues found that male great bustards ate more blister beetles, which can be toxic at high doses, during the breeding season. The beetles’ chemical composition appeared to have a pharmaceutical effect against parasites, he says.

Bautista-Sopelana wondered if that might also explain why the birds prefer to eat common poppies (Papaver rhoeas) and purple viper’s-bugloss (Echium plantagineum) – plants that are toxic to some extent and have little nutritional value – during the breeding season.

He and his colleagues collected these plants at one of the largest bustard breeding grounds, near Valdetorres del Jarama, Spain. They then used standard laboratory techniques to acquire 17 extracts and essential oils from the leaves and flowers of each plant.

Afterwards, the researchers placed individual extracts and oils in separate laboratory dishes containing organisms that commonly infect birds: a protozoan parasite (Trichomonas gallinae), a nematode worm (Meloidogyne javanica) or a fungus (Aspergillus niger).

They found that extracts and oils from the plants had notable effects on the pathogens. For example, certain flower extracts killed up to 98.6 per cent of the protozoa and up to 81.3 per cent of the worms. Purple viper’s-bugloss also showed a moderate impact on the fungus, with its flower extracts inhibiting growth by up to 52 per cent.

In addition, the team re-analysed 623 faecal samples collected for a previous and found that great bustards of both sexes increased the amount of common poppies in their diets during the breeding season, but this was more pronounced in males.

The researchers think males may be more interested in medicinal plants because their mating displays use a lot of energy, making them more vulnerable to infections.

There have been numerous studies suggesting that wild animals probably self-medicate, says Bautista-Sopelana. “It is not a phenomenon unknown to specialists,” he says. “After reading the scientific literature on self-medication in wild animals, we are less surprised than when we started the research.”

Even so, further studies are needed, he says. “Although the efficacy of self-medication in bustards is far from proven, the behaviour of bustards in selecting these plants requires an explanation. And it seems unlikely to be purely nutritional.”

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A vaccine designed to protect koalas against chlamydia is being tested in a large clinical trial in Queensland, Australia.

Australia’s koalas are in the grip of a chlamydia epidemic, with for the sexually transmitted infection. Its rapid spread is thought to be a major driver of plummeting koala numbers.

at the University of the Sunshine Coast in Queensland and his colleagues have spent more than a decade developing a vaccine to protect koalas against the disease, which can lead to painful urinary tract infections, loss of bladder control, infertility, blindness and death.

The vaccine exposes koalas to small fragments of the Chlamydia pecorum bacterium that can infect them. This trains the immune system to recognise and attack the pathogen if they become infected.

Eight small studies have shown that the vaccine protects koalas from getting sick if they catch chlamydia and can also reduce symptom severity in those that are already infected.

In the current trial, which is the biggest yet, the vaccine will be given as a single injection to 200 koalas at the Australia Zoo Wildlife Hospital in Beerwah, Queensland. The trial began on 15 October, with a koala called Shano receiving the first jab (pictured).

To evaluate the vaccine’s efficacy, Timms and his colleagues will assess how many of the 200 vaccinated koalas are hospitalised with chlamydia symptoms over the next 12 months compared with 200 unvaccinated koalas.

If the vaccine is approved for widespread use, “it could help to turn around populations of koalas that might disappear”, says Timms. His team has already found that the vaccine, combined with other veterinary care, was effective at reversing declining koala numbers in an area of south-east Queensland.

It may be possible to use similar principles to develop a vaccine for human chlamydia, which is caused by the related bacterium Chlamydia trachomatis, says Timms. “I think this trial will be closely watched by the human chlamydia vaccine world,” he says.

New rules that make it easier for gay and bisexual men in the UK to donate blood have been found to be safe, but equal rights campaigners say they don’t go far enough to eliminate discrimination.

Most rich countries, including the US and Australia, only allow men who have sex with men to donate blood if they have abstained from sex for at least 12 months, because men in these countries have a higher risk of getting HIV and hepatitis from sex. In the US, for example, of new HIV infections result from male-to-male sexual contact.

All donated blood is tested before it is used, but it takes time for recent HIV and hepatitis infections to become detectable, which is why most countries ask that higher-risk donors avoid sex for a period of time before giving blood. However, modern screening tests can detect HIV and hepatitis within one month of a person being infected. In November 2017, England, Scotland and Wales shortened the time that men who have sex with men have to abstain from sex before donating blood to three months, on the advice of the UK’s Advisory Committee on the Safety of Blood, Tissues and Organs.

Two years in, this policy change hasn’t compromised the safety of the UK’s donor blood supply, says Katy Davison of Public 91ɫ��Ƭ England, who presented the first data at a meeting of the AABB international blood bank association in San Antonio, Texas.

There was no significant rise in infected blood. Out of 2 million blood donations made in the UK in 2018, seven tested positive for HIV, compared with six in 2017. These donations were discarded and no transfusion recipients received HIV-infected blood, she told the meeting.

In addition, 89 blood donations tested positive for hepatitis in 2018, compared with 102 the previous year. Blood transfusions resulted in one person becoming infected with hepatitis B and another with hepatitis E, but this was below the required rate of no more than one infection per 1 million transfusions.

Several other countries have followed the UK’s lead. Canada moved to a three-month abstinence period in June, and France, Denmark and the Netherlands have approved four-month abstinence periods.

However, activist group Freedom to Donate says these new rules are still discriminatory because they group people together based on sexuality rather than individual behaviour. It wants governments to introduce individualised risk assessments that would allow men who have sex with men with low-risk sexual behaviour – like those in monogamous relationships or who always use protection – to donate blood without having to abstain from sex.

Illegal blood bank

To try to prove the safety of this approach, Freedom to Donate invited 26 gay and bisexual men to donate blood at an “illegal blood bank” in a secret location in London on 23 November. Before donating, participants filled out a questionnaire about their sexual behaviour. Their donations will now be tested to show that blood from “low-risk” men who have sex with men is safe to use. “The blood will not be used medically in the current system, but to prove the point,” the organisers said.

However, Mindy Goldman at Canadian Blood Services says that testing 26 men isn’t adequate to prove this point. Since HIV transmission risks are low, hundreds of thousands of men would need to be tested to confirm the safety of individualised risk assessments, she says. Statistical modelling is a better way to explore the safety of this approach, she says.

Spain and Italy have used individualised risk assessments to decide who can donate blood since 2000 and 2001, respectively. HIV is found in slightly more of their blood donations, but the risk of transmitting this to recipients of blood transfusions is very low because of screening tests. In Italy, for example, the risk of getting HIV from a blood transfusion is estimated to be 1 in 13 million.

One major question that needs to be addressed before individualised risk assessments can be introduced more widely is whether people taking pre-exposure prophylaxis (PrEP) drugs can safely donate blood, says Brian Custer at US blood research institute Vitalant. These medicines, which were approved by the US Food and Drug Administration in 2012, lower the risk of getting HIV from sex by about 99 per cent when taken properly. But HIV can still be contracted if PrEP is taken inconsistently, and the virus may not show up in screening tests because PrEP reduces the viral load in the blood, says Custer.

“PrEP is fundamental to the success in controlling the HIV epidemic, but for blood safety we have to be very cautious so as to not face the possibility of new cases of transfusion-transmitted HIV,” says Custer.

In the UK, the FAIR (For the Assessment of Individualised Risk) steering group of the UK Blood Services is exploring whether individualised blood donation risk assessments could be safely introduced. This isn’t to address blood shortages – since the UK already has enough blood donors – but to be more inclusive.

FAIR says it will report its findings to the government in late 2020. Canada is conducting its own research on individualised risk assessments and the US plans to start next year.