The rise of super-gonorrhoea and antibiotic resistance

By Lizzie Harrett

Super-gonorrhoea: it’s back in the headlines, increasing in number and spreading across the country. Gair Rhydd Science reported way back in October that several cases of an antibiotic-resistant strain of the sexually transmitted infection (STI) had been detected in North West England.

However, a press release by Public Health England (PHE) has now confirmed 34 incidences of gonorrhoea detected that are resistant to the antibiotic azithromycin between November 2014 and April 2016. These cases have been reported around the country, with the outbreak spreading to the West Midlands and London. The initial cases reported in October were just among individuals who were involved in sexual activity with the opposite gender, but it is now also being reported in homosexual men.

Gonorrhoea is also known as “The Clap” and is caused by the bacteria Neisseria gonorrhoeae. It is spread through sexual activity, with symptoms including sore genitals and a burning sensation when peeing. However, approximately 1 in every 10 infected men and half of women do not experience any symptoms. If left untreated it can result in painful infections of the genitals in men and lead to pelvic inflammatory disease in women, which can cause miscarriage and result in infertility.

In the UK, it is treated by a course of two antibiotics; azithromycin which is orally administered, and ceftriaxone that is injected. This is so if bacteria is resistant to one, it is killed by the other. The reported cases of this super-gonorrhoea are therefore only killed by the ceftriaxone, which means that it could potentially rapidly build up a resistance to this drug too – gonorrhoea is notorious for quickly building one up. However, if this happens then we will be all out of options. Super-gonorrhoea will be totally untreatable, which could be a health disaster for clinicians and epidemiologists.

While 34 cases may sound like a drop in the ocean when there are 70 million people living in the UK, the issue is with how quickly it could spread if those who are infected have multiple sexual partners. Worryingly, PHE confirmed that out of all of those diagnosed with the strain of super-gonorrhoea, partner notification levels were incredibly low. Just 22 per cent of all the partners reported were successfully notified. Scientists who analysed the genetic makeup of the bacteria showed that they were related to previously reported cases, and were recently transmitted.

Dr Mark Lawton, a spokesman for the British Association for Sexual Health and HIV, has said that research is partly emerging due to individuals who test positive for gonorrhoea buying treatments online confidentially from internet stores. You can only buy non-injectable drugs online, so instead of buying ceftriaxone they are purchasing the oral drug cefixime. This is not as effective as ceftriaxone as it does not penetrate the tissues which can host the bacteria very well This puts the pressure on azithromycin to treat the infection, putting it at a much greater risk of bacteria developing a resistance to it.

The rise of antibiotic resistance in gonorrhoea is part of a much wider picture of an unprecedented health challenge facing the world. In a 2014 World Health Organisation (WHO) report on this problem, they noted that antibiotic-resistance was present in bacteria responsible for common and serious health diseases. These include blood infection, urinary tract infections and pneumonia. They stated that these results were a cause for high concern, especially as resistance is being found in “last resort” antibiotics – such as azithromycin in Gonorrhoea.

Bacterial resistance occurs due to natural selection, which is Darwin’s theory of survival of the fittest. When bacteria reproduce, random mutations can cause changes to their genetic makeup. This includes altering the mechanisms that antibiotics attack. If a mutation causes bacteria to survive a course of antibiotics, those which resist the treatment will be the only survivors. They will then reproduce, passing on the genes which confer this survival to their progeny and causing resistance to spread.

The WHO Assistant Director-General for Health Security, Dr Keiji Fukuda, highlighted the need for critical action, saying: “Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.” He added, “Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and take antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.”

PHE are spearheading the response to the outbreak of this antibiotic resistant drug, with protection teams supporting local work to prevent further dissemination of this strain through enhanced data collection, interventions and communications to raise awareness among affected communities.

Dr Gwenda Hughes, consultant scientist and head of the STI section at Public Health England urged individuals to reduce their risk through “using condoms with all new and casual partners,” as well as getting regularly tested for STIs in order to get treatment before taking up new sexual partners and potentially furthering the spread of the disease.

When looking at the larger problem of antibiotic resistance, a much greater strategy is needed. The WHO have developed a large-scale plan, which includes offering better global access to improved hygiene, access to clean water and better infection control – all with the aim of reducing the need for antibiotics. There is also a push for researchers to develop new antibiotics.

However, when looking at super-gonorrhoea, the easiest way to avoid it is of course to follow Dr Hughes’ advice and the age-old mantra: don’t be a schmuck, wrap it up.

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