Oral sex is producing dangerous gonorrhoea and a decline in condom use is helping it to spread, the World Health Organization (WHO) has said.
It warns that if someone contracts gonorrhoea, it is now much harder to treat, and in some cases impossible.
The sexually transmitted infection is rapidly developing resistance to antibiotics.
Experts said the situation was “fairly grim” with few new drugs on the horizon.
About 78 million people pick up the STI each year and it can cause infertility.
WHO analysed data from 77 countries which showed gonorrhoea’s resistance to antibiotics was widespread.
Dr Teodora Wi, from the WHO, said there had even been three cases – in Japan, France and Spain – where the infection was completely untreatable.
She said: “Gonorrhoea is a very smart bug, every time you introduce a new class of antibiotics to treat gonorrhoea, the bug becomes resistant.”
Worryingly, the vast majority of gonorrhoea infections are in poor countries where resistance is harder to detect.
“These cases may just be the tip of the iceberg,” she added.
Gonorrhoea can infect the genitals, rectum and throat, but it is the last that is most concerning health officials.
Dr Wi said antibiotics could lead to bacteria in the back of the throat, including relatives of gonorrhoea, developing resistance.
She said: “When you use antibiotics to treat infections like a normal sore throat, this mixes with the Neisseria species in your throat and this results in resistance.”
Thrusting gonorrhoea bacteria into this environment through oral sex can lead to super-gonorrhoea.
“In the US, resistance [to an antibiotic] came from men having sex with men because of pharyngeal infection,” she added.
A decline in condom use, which had soared because of fears of HIV/Aids, is thought to help the infection spread.
WHO has called on countries to monitor the spread of resistant gonorrhoea and to invest in new drugs.
