Doctors are "a hair's breadth" away from being unable to treat gonorrhoea with antibiotics, say two Kiwi researchers pressing for urgent action.
Gonorrhoea is a common, easily spread, sexually transmitted bacterial disease that has modified its genetics over time.
In most countries, including New Zealand, only one antibiotic treats it.
Writing in the Biochemist, Massey University researchers Dr Heather Hendrickson and Dr Collette Bromhead note how gonorrhoea has evolved swiftly and mercilessly to resist every class of antibiotics introduced since the mid-1930s.
"In most countries, the only options for first-line treatment are injectable antibiotics," Bromhead said.
"However, in 2012, we found the first scary genetic signatures of resistance to these drugs circulating in New Zealanders.
"We are only a hair's breadth away from being unable to treat gonorrhoea with antibiotics at all."
The threat was made all the more serious by the fact that only about one in 10 infected men and almost half of infected women do not experience any symptoms, allowing the nasty infection to spread more easily.
"To make things worse, many pharmaceutical companies have lost interest in pursuing the expensive research and development needed to develop novel antibiotics because rapid resistance leads to a failure to recuperate their investments," Bromhead said.
"Without new treatment options, we face a return to the pre-antibiotic era, and the days of devastating childhood mortality, amputation and infections that can kill millions of people."
But there was still hope to stay ahead of it.
Bacteriophages, or phages as they are more simply known, are used today in Russia, Georgia and Poland to fight bacterial infections.
Protein-based entities that attach to bacterial cells and infect them, phages only target the bacteria they are meant to kill, eliminating any disruption of the greater microbiome that can occur with some antibiotics.
Hendrickson said the top priority was to preserve remaining antibiotics by embracing the principles of antibiotic stewardship.
"In other words, we must stop abusing antibiotics for things like viral infections," she said.
"On a personal level, get yourself and your children immunised with every single vaccine your healthcare provider recommends, even if you have to pay for it.
"And keep an eye out for the release of new vaccines."
"The public genuinely needs to figure out what is more frightening when it comes to protecting the young and vulnerable: sex or untreatable infections?"
Antibiotic resistance was a problem for everyone, not just doctors, scientists and pharmaceutical companies, she said.
"Health protection agencies must move from being reactive to proactive.
"We need to find new ways of incorporating phage and phage products into medicine.
"If we don't win this fight, the bugs wil carry on here long after we have disappeared."