An Austrian man, who had unprotected sex abroad and experienced pain days after, caught a new strain of so-called “super gonorrhea” that is resistant to most antibiotics commonly used to treat the infection, scientists have said.

This is the second time a “super gonorrhea” strain has been detected, after another was found in 2018 in multiple countries. The term “super gonorrhea” refers to a bug that has a high level of resistance to current recommended treatments, according to the World Health Organization.

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If multi-drug resistant strains of gonorrhea keep spreading, many cases of the STD might become untreatable, according to the authors of a case report published in the medical journal Eurosurveillance, which is published by the European Centre for Disease Prevention and Control.

Most cases of gonorrhea don’t produce symptoms, but can still cause serious complications such as infertility if it is not possible to treat the infection. Symptoms include discharge and pain when a person pees, and painful testicles or irregular vaginal bleeding.

The unidentified man in his fifties had condomless sex with a female sex worker in Cambodia in April 2022, according to the case report. Five days later, he experienced pain while peeing and had discharge coming out of his penis.

A swab revealed the strain he caught was highly resistant to azithromycin, which is typically one of the first antibiotics used to treat gonorrhea, and resistant to other antibiotics including: ceftriaxone, cefixime, cefotaxime, ciprofloxacin, and tetracycline.

Gonorrhea treatment varies from country-to-country, but tends to start with a combination of azithromycin and ceftriaxone. In the US, the CDC recommends ceftriaxone as a single antibiotic for most gonorrhea cases in the first instance.

The man was initially treated with azithromycin and ceftriaxone. Two weeks later his symptoms resolved, but a penile swab still showed he had gonorrhea. Tests showed his “super” bug was still susceptible to treatment with an antibiotic containing penicillin called co-amoxiclav. The drug appeared to treat the gonorrhea, the scientists said.

The case report authors said that “promisingly,” the man’s swab results suggested two experimental drugs called lefamulin and zoliflodacin, would also likely to work against it. These two medicines are being tested in a late-stage clinical trial, they said.

Using condoms is one of the main ways to avoid catching gonorrhea

Gonorrhea, caused by a bacteria called Neisseria gonorrhoeae, is one of the most commonly reported sexually transmitted infections in the US, with more than 1.5 million Americans catching it each year, according to Centers for Disease Control and Prevention estimates.

The CDC says on its website that using condoms during sex and having monogamous sex with an uninfected person are the only ways to cut the risk of contracting any strain of gonorrhea.