Quick Answer: Super gonorrhea and Mycoplasma genitalium are two STDs increasingly resistant to common antibiotics. If your symptoms don’t improve after treatment, or come back quickly, you may need retesting and alternative medications.
When Pills Stop Working: Why AMR Matters in Sexual Health
In most people’s minds, STDs are annoying but fixable. A quick clinic visit, a round of antibiotics, and done. But that’s changing fast. Infections that once cleared with a single dose now linger. In some cases, they come back stronger, because the bacteria survived the drugs.
This is the brutal reality of AMR: bacteria evolve, medications don’t. The CDC has classified drug-resistant gonorrhea as an urgent public health threat. The World Health Organization now includes Mycoplasma genitalium on its list of emerging resistant STIs. Unlike other STDs, these can remain completely asymptomatic, until complications like infertility or pelvic pain set in.
For many, the first sign something’s wrong isn’t a rash or discharge, it’s that the usual treatment just... doesn’t work. That’s when AMR has already entered the chat.
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What Is Mycoplasma Genitalium, and Why Is It So Hard to Treat?
Mycoplasma genitalium (often called Mgen) is a tiny, slow-growing bacterium that infects the urinary and genital tracts. It’s easily confused with other infections like chlamydia or non-gonococcal urethritis because the symptoms, when they appear at all, are vague: irritation when you pee, spotting after sex, pelvic pain.
But what makes Mgen especially dangerous is its resistance profile. It’s naturally resistant to many antibiotics, and standard drugs like azithromycin often fail. Studies show up to 50% of Mgen cases in some regions are resistant to first-line treatments. Second-line drugs like moxifloxacin come with their own risks, including severe side effects and reduced effectiveness over time.
In one study, 44% of people treated for Mgen required multiple courses of medication. That’s not just frustrating, it’s a public health crisis in the making. Every failed treatment increases resistance. And because many doctors don’t test for Mgen routinely, patients get misdiagnosed and mistreated.
Super Gonorrhea: Not Science Fiction Anymore
When headlines first mentioned “super gonorrhea,” it sounded like clickbait. But it’s terrifyingly real. This strain of Neisseria gonorrhoeae has mutated to resist nearly every class of antibiotics once used against it. And while it still responds to a few drugs in the U.S., treatment failures have already been documented worldwide, including in Australia, the U.K., and Asia.
Most cases of gonorrhea are still curable, but barely. The CDC now recommends a higher-dose injectable cephalosporin for treatment, but this isn’t a casual fix. It requires in-clinic administration, and follow-up is essential. People with untreated or undertreated gonorrhea may unknowingly transmit the resistant strain through vaginal, oral, or anal sex.
The scariest part? Oral infections. Gonorrhea in the throat often has no symptoms at all. It can linger in tonsillar tissue, survive antibiotic exposure, and jump to partners through kissing or oral sex. This stealth behavior makes it a perfect vehicle for resistance to spread silently.
Why Testing Isn’t Always the End of the Story
Testing is essential, but it’s not foolproof, especially with resistant infections. Standard NAAT tests (nucleic acid amplification) can detect gonorrhea and Mgen, but they won’t tell you if the strain you’ve got will respond to treatment. That information usually requires culture testing and resistance profiling, tests that aren’t widely available in urgent care or telehealth settings.
That means a lot of people are getting diagnosed correctly but treated ineffectively. You take your meds, your symptoms fade (or not), and you assume you’re cured. Meanwhile, the bacteria may still be alive, stronger, smarter, and now partially resistant to the drug you just took.
One CDC report showed that 1 in 20 people diagnosed with gonorrhea will test positive again within 3 months, not always because of reinfection, but because the bacteria wasn’t fully eradicated the first time.
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The Oral Sex Dilemma: Kissing the Cure Goodbye
Here's a scenario public health teams are seeing more often: two people hook up, use condoms for penetration, skip them for oral. A week later, one develops a mild sore throat; the other gets no symptoms. Neither considers an STD. If they test, it’s often only genital, not throat swabs. If they’re treated, the oral reservoir may go untouched.
This is how drug-resistant STDs keep spreading. The throat, especially when asymptomatic, is a perfect incubator. Gonorrhea can survive there even after treatment. In one study on oral STDs, over 60% of positive cases had no symptoms at all, and most weren’t detected until a partner tested positive later.
It’s not just gonorrhea. Mycoplasma genitalium has been detected in the oropharynx as well, though less commonly. Still, this calls for expanded testing habits, and open conversations. Oral sex is sex. And it can carry the same bacterial risks.
When the Pills Didn’t Work
Nina, 26, had a new partner, consistent condoms, and no symptoms, until post-sex spotting and pelvic pain started. A clinic test showed positive for Mgen. She took azithromycin as prescribed and felt better. But three weeks later, the pain was back, worse this time. Her doctor suspected reinfection. Another round of antibiotics. This time, no improvement.
After six weeks of appointments, tears, and painkillers, Nina was referred to a specialist. Her Mgen strain was macrolide-resistant. Only a rare fluoroquinolone worked, and it came with gut-wrecking side effects.
“I didn’t even know this STD existed. No one told me it might not respond to the pills they gave me. I thought I was being careful.”
Her story isn’t rare. Up to 20% of Mgen infections in some populations require multiple treatment rounds. And that number is growing.
Drug-Resistant STD Infections and First-Line Failures
| STD | Estimated Resistance Rate | Common First-Line Treatment | Reported Failure Rate | Alternative Required |
|---|---|---|---|---|
| Mycoplasma genitalium | 40–60% | Azithromycin | Up to 50% | Moxifloxacin or Pristinamycin |
| Gonorrhea | 20–30% (varies by region) | Ceftriaxone (injection) | 5–10% | High-dose dual therapy or culture-based guidance |
| Chlamydia | Low | Doxycycline | 1–2% | Alternative antibiotic regimen |
Figure 1. Resistance data sourced from WHO, CDC, and recent clinical reviews of treatment efficacy in drug-resistant STIs.
Testing That Goes Deeper
If your symptoms didn’t clear after antibiotics, or if you were treated but never tested, you might be dealing with a resistant strain. Testing again is not a sign of failure. It’s the smartest move you can make for your body and your partners.
Most at-home combo test kits now include throat and genital swabs, letting you test the sites that matter. Look for options that screen for gonorrhea and Mgen, especially if your symptoms persist or your partner was recently treated.
If your head keeps spinning, peace of mind is one test away. STD Rapid Test Kits offers discreet, doctor-trusted solutions that respect your privacy and urgency.
People are also reading: You Have Gonorrhea. Don’t Panic, Here’s How to Handle It
When You Need to Retest, and Why It Matters
It’s easy to think of STD testing as a one-and-done event. But when drug resistance is involved, retesting isn’t just smart, it’s essential. Even if you were treated properly, your body might still be harboring bacteria that weren’t fully eliminated. And if you’re still having symptoms, or they return a few weeks later, that’s your body waving a red flag.
According to the CDC’s guidance on Mycoplasma genitalium, retesting is recommended after 21 days to confirm clearance. For gonorrhea, especially oral cases, a 14–30 day follow-up window is best if symptoms remain or a partner retests positive. This isn’t about being paranoid, it’s about being safe, especially in an era where resistance is growing faster than treatment innovation.
Retesting Guidelines for Common Drug-Resistant STDs
| Infection | Initial Treatment Time | When to Retest | Why Retesting Matters |
|---|---|---|---|
| Mycoplasma genitalium | 7–10 days | 21–28 days post-treatment | Resistance is common; early relapse likely if strain isn’t cleared |
| Gonorrhea (Genital) | Same-day injection | 14–30 days if symptoms persist | Drug resistance or reinfection possible even after clinical treatment |
| Gonorrhea (Oral) | Same-day injection | 21–30 days minimum | Oral strains are harder to treat and more resistant |
Figure 2. Clinical recommendations for follow-up testing after initial treatment of resistant or high-risk STDs. Based on CDC and WHO treatment guidelines.
How to Talk to a Partner About a “Hard-to-Treat” STD
There’s never a perfect script for telling someone you might have given them a drug-resistant infection. But honesty is the only option that respects both your health and theirs. The truth is, we’re all at risk, and framing the conversation that way can reduce shame on both sides.
Try this: “I got tested recently and found out the infection I had might not have responded to the meds. I care about you, and I think you should know in case you want to test again too.” No blame. No panic. Just facts and care.
If you’re anxious about initiating that dialogue, some services offer anonymous partner notification via text or email. But even a single direct message can prevent reinfection or further spread, especially when dealing with AMR.
“I thought I did everything right,” said Luis, 33, who had to message three partners after learning his throat gonorrhea was resistant. “But I also know that talking about it probably stopped it from getting worse.”
Your Power Move: Get Ahead of Resistance
You don’t have to wait for symptoms to strike, or for another round of antibiotics to fail. The most powerful thing you can do is test smart, test early, and test thoroughly. That means choosing at-home kits that include multi-site swabs (genital and oral), knowing when to retest, and understanding what a failed treatment might mean.
Whether it’s a bump, a burn, or just a weird feeling that something’s off, don’t wait for it to go away. It might not. And if you’re sexually active with multiple partners or explore oral sex regularly, you owe it to yourself to include throat testing in your routine.
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FAQs
1. Wait, what exactly is super gonorrhea?
It’s not a comic book villain, but it’s close. “Super gonorrhea” is a real strain of gonorrhea that’s resistant to nearly every antibiotic we’ve got. It doesn’t come with a cape, but it can definitely mess up your week, especially if it's hiding in your throat or rectum where symptoms stay silent.
2. Is Mycoplasma genitalium even an STD?
Yep, and it’s one of the sneakiest. Mycoplasma genitalium (aka Mgen) is tiny, hard to detect, and often misdiagnosed as a UTI or chlamydia. It can cause painful urination, spotting, and pelvic pain, or absolutely nothing. And the kicker? It laughs in the face of common antibiotics.
3. What if I still have symptoms after antibiotics?
That’s your cue to speak up and retest. Persistent burning, discharge, pelvic pain, or even “just not feeling right” a week or two after treatment isn’t paranoia, it could be resistance. It doesn’t mean you’re dirty or did something wrong. It means your bacteria came to play.
4. Can oral sex really spread drug-resistant gonorrhea?
100% yes. The throat is one of the main places resistant gonorrhea hides. It’s like a stealth mode infection, no symptoms, no signs, but still spreading. And most people don’t test their throat unless they specifically ask for it. So if oral sex is part of your life, oral testing should be too.
5. Do at-home STD kits check for this stuff?
Many do, but not all. Look for kits that test for gonorrhea and Mycoplasma genitalium, and that include throat swabs if that’s relevant to how you have sex. Just remember: home tests tell you if you have it, but not if it’s drug-resistant. That’s where retesting after treatment comes in.
6. I told my partner I had gonorrhea, but now it’s back. Did they reinfect me?
Maybe. Or maybe the first round of antibiotics didn’t fully kill it. This is why retesting after 2–3 weeks is so crucial. And it’s why your partner should test too, even if they have no symptoms. You’re not pointing fingers. You’re playing defense together.
7. Can you get these infections just from kissing?
The science is still unfolding, but for gonorrhea, deep kissing (especially with open mouth or shared fluids) might be a risk, especially if someone has a throat infection. Think of it like sharing drinks at a party: most of the time fine, but sometimes…not so much.
8. What happens if I test positive again after treatment?
First: deep breath. Second: don’t panic. You may need a different medication, and possibly resistance testing. The point is, your test is telling you the truth. It’s not judging you, it’s giving you a shot at getting it right this time.
9. Should I stop having sex if I have a resistant STD?
Pause, not forever, but for now. Until you’re retested and cleared, it’s best to lay low (or at least use protection and full transparency). Most people don’t know how common resistant STDs are, so talking about it helps shift the culture toward safety, not shame.
10. How do I avoid this in the future without giving up sex?
You don’t have to stop having sex, you just have to get smarter about testing. Include oral sites. Retest after treatment. Use condoms or barriers when you can. And if someone tells you they “just got treated,” smile and ask when they’re retesting. That’s foreplay now.
You Deserve Answers, Not Assumptions
If you’ve been treated but still don’t feel right, you’re not imagining things. The landscape of STD care is changing, and pretending otherwise only leaves more people hurt, confused, and untreated. AMR isn’t your fault. But your response can make all the difference.
Don’t wait and wonder, get the clarity you deserve.
How We Sourced This Article: We combined current guidance from leading medical organizations with peer-reviewed research and lived-experience reporting to make this guide practical, compassionate, and accurate. In total, around fifteen references informed the writing; below, we’ve highlighted some of the most relevant and reader-friendly sources.
Sources
1. CDC Guidelines on Mycoplasma genitalium
2. WHO: Antibiotic Resistance Overview
3. Gonococcal Infections Among Adolescents and Adults — CDC STI Treatment Guidelines
4. Drug‑Resistant Gonorrhea — CDC
5. Mycoplasma genitalium: An Overlooked Sexually Transmitted Infection — PMC
About the Author
Dr. F. David, MD is a board-certified infectious disease specialist focused on STI prevention, diagnosis, and treatment. He blends clinical precision with a no-nonsense, sex-positive approach and is committed to expanding access for readers in both urban and off-grid settings.
Reviewed by: Jamie L. Kim, MPH | Last medically reviewed: November 2025
This article is for informational purposes and does not replace medical advice.
