Neisseria gonorrhoeae. Photo: CDC/Bill Schwartz

With the concerning rise in Gonorrhea’s antibiotic resistance, new research has been published from Tufts University of the first full comparison of gonococcal gene expression and regulation in men and women infected with the Neisseria Gonorrhoeae strain.

This research dives deeper into the understanding of Gonorrhea’s prevalence in men and women by identifying signatures of resistant genes and infection that are gender specific.


Decline in resistance

Able to outsmart antibiotics, Gonorrhea has recently grown resistance to multiple treatments that were once effective such as ciprofloxacin and two cephalosporins, called ceftriaxone and cefixime.

These treatments have declined drastically in effectiveness over the last decade. 

In 2013, the Centers for Disease Control and Prevention added Neisseria Gonorrhoeae to the list of urgent public health threats with the rise of the strain’s antimicrobial resistance.

There are additional concerns voiced by the CDC pertaining to the fact that there is currently only one effective class of recommended antibiotics left for Gonorrhea, known as cephalosporins.

This new research could possibly assist in finding effective, and hopefully longer-lasting, treatments for a sexually transmitted disease that, according to the World Health Organization, effects 78 million people annually around the globe.


Gender Matters

Past research only analyzed tissue culture, male human models and mice, but neglected to study the comparison of Gonorrhea between male and female subjects.

It is known that different genders have complex, different bodily environments, meaning that Gonorrhea has vastly different implications in women and men.

”We built on our earlier work on gene expression during infection in females to include both genders in the present analysis, so we see for the first time the expression profiles during active disease in males and their asymptomatic partners,” Carolina Genco, professor and chair of the Department of Immunology at Tufts University School of Medicine, said. “Studying active natural infection in both men and women is critical to develop strategies to treat and prevent infection.”

Men have more obvious symptoms and women have less obvious symptoms that are mild, such as asymptomatic symptoms, the researchers note.

After observing the disease manifest in a study that consisted of both men and women, Tufts researchers found that men and women have similar antibiotic resistant genotypes, but the genotype in men was 4 percent higher than in women.

The expression of these bacterial genes were identified through RNA sequencing of the men and women.

The team also discovered that there was a notable difference between the gene expression profiles of the men and women.

There was an increased expression of gonococcal genes in men compared to women by 9 percent, as well as increased expression of phage-associated genes in women by 4 percent.

The analysis was made after collecting samples from men who sought treatment in a country with higher rates of gonorrhea and antibiotic resistance.

Samples of female partners of men who were diagnosed with gonorrhea were also collected.

The findings that the impacts on gender differ when infected could help researchers have a greater understanding of this urgent public threat.