Sexual Health Monday April 18, 2016

Could 'Super Gonorrhoea' Spread Across The UK?

Gonorrhoea is a staple of sexually transmitted infections (STIs) collection. In fact, when we took Dr Hilary out on the streets of London, asking you what STIs spring to mind, good ol' gonorrs was always near the top of the list along with chlamydia, herpes and genital warts.

Also known as 'clap', it is the second most common STI in the UK, after chlamydia, and the number of infections each year is increasing; there were 29,400 cases reported in 2013 and nearly 35,000 occurred in 2014, an increase of 19%.

It's also one of the world's oldest STIs having been well documented in the UK as early as the 16th century, and even having a possible mention in the Bible. Being a bacterial infection, it's always required a course of antibiotics to completely clear up the infections and its accompanying symptoms. Until now.

The UK's Chief Medical Officer, Dame Sally Davies has recently warned that gonorrhoea could soon become untreatable with current antibiotics being obsolete towards the infection.

HealthExpress first reported on this back in 2011 after Swedish researchers discovered a new, more resistant strain of gonorrhoea, way before we caught wind of it. The first case was identified in Japan and, although there is currently no way of knowing how widespread this strain of the virus is, scientists warn that there is the potential for it to turn into a global public health issue, and it seems like it's hit the UK with reports in the Macclesfield and Leeds.

But what does this all mean?

So, what's the clap?

We have more about gonorrhoea on our condition information page, but as a brief overview:

Gonorrhoea is spread through unprotected vaginal, anal and oral sex, and is often asymptomatic for the vast majority of people (male or female). If you contract it you may not be aware, as there are often no symptoms. When symptoms occur, these can include a green or yellow discharge from the vagina or penis, pain when urinating, bleeding between periods, itchy, sore rashes and painful bowel movements. Even if there are no symptoms, the virus can still be transferred to others, which makes the rates of gonorrhoea in comparison to other STIs so high and the development of the incurable infection so prominent in the news.

Is Having Gonorrhoea Your Entire Life Really So Bad?

Well, it's not great, is it. Like with herpes, genital warts and other incurable STIs, it can make life that little bit more annoying. For example, outbreaks of herpes and warts require treatment that can be pricey, or uncomfortable symptoms come about interrupting your otherwise, and you are eventually passing it around with other partners.

Viral STIs can be a pain, but ultimately they are extremely manageable. The bouts often lessen in the discomfort factor, you begin to learn more about the condition and which treatment cure the outbreak fast and how to enjoy sex with the condition. It is also uncommon for viral STIs to cause long-term complications, however gonorrhoea does. This means the need to cure the infection with new highly effective antibiotics is even more important.

If left untreated, the infection can spread to other parts of the body, causing serious problems. It can lead to infertility for both men and women and increase a woman's chance of ectopic pregnancy. As the infection spreads around the body via the bloodstream, it can even be life threatening. Those infected with gonorrhoea are also more vulnerable to the HIV virus.

What Is This 'Super Gonorrhoea'?

We're all loving a bit of Marvel at the minute, so it sounds spectacular, doesn't it. 'SUPER GONORRHOEA SAVES THE DAY'! Quite the opposite.

The new strain of gonorrhoea bacteria, called H041, is able to mutate, which is why it's able to resist antibiotics that can effectively treat and kill other strains of the virus. Normally, cephalosporin antibiotics (those similar to penicillin) are used to treat clap however, even when these medications are used, the bacterium has been shown to be resistant to treatment.

Just like with most other types of bacterial STIs, gonorrhoea doesn't cause people to display symptoms straight away, with around 50% of men and women displaying no symptoms at all over the entire course. This is why it's important to ensure that you go for regular tests if you are sexually active and get the right treatment if it's possible.

What's Wrong With Antibiotics?

All this demonstrates just what life must have been like for someone with gonorrhoea in the past. Popular 'treatments' used to include mercury and silver nitrate, injected into the urethra. Needless to say, these probably weren't very effective, or will you be able to purchase your own vial of mercury to inject up you anytime in the future. So we need to look for other effective options before super gonorrhoea spreads even further.

Following the introduction of antibiotics, for many years, the preferred treatment was a simple course of tablets. However, the rise of antibiotic resistance is now putting treatment for this and other STIs in jeopardy. Many of the antibiotics that used to work, such as penicillin and tetracycline, are no longer effective in treating gonorrhoea.

Unfortunately some parts of the medical profession have been slow to catch on to this. A 2015 study by Public Health England revealed that doctors were still prescribing the antibiotic ciprofloxacin as treatment for gonorrhoea despite this not having been recommended since 2005.

In March 2015, a highly drug-resistant strain of gonorrhoea was detected in the Leeds, with at least twelve cases shaking off the standard antibiotic treatments azithromycin and ceftriaxone. Similar trends have been reported in the USA and Australia. If this continues, we could be in big trouble.

Looking For Solutions

Researchers are currently working on finding a medication to delay the spread of the bacteria, but Dr David Livermore director of the antibiotic resistance monitoring laboratory from the Health Protection Agency warns that prevention is the only option until they've found a way to control the bacteria.

" Prevention is better than cure, especially as a cure becomes harder to achieve, and the most reliable way to protect against STIs - including resistant gonorrhoea - is to use a condom with both new and casual partners." Dr David Livermore, Director of the Antibiotic Resistance Monitoring Laboratory, Health Protection Agency

He also said that antibiotics currently used to treat other strains are still effective, however their research showed that other strains of the bacteria are also becoming more resistant. This means that in some cases, antibiotics need to be alternated or the doses need to be increased. This why LabsDirect encourages all our patients to wait two weeks after completing a course of antibiotics to check that it has been effective.

The main concern for experts is the importance of stamping out this resistant strain of the infection before it spreads. At the moment, the most predominant strain of gonorrhoea does still respond to treatment. Therefore it is essential that anyone who suspects they may have the infection pay a visit to their GP or a sexual health clinic as soon as possible.

Currently the recommended treatment for gonorrhoea is an antibiotic injection followed by one antibiotic tablet, as this has been shown to be more effective in combating resistance. This can be administered at a GUM clinic or even in some pharmacies or doctor's surgery. If you prefer to see your GP, check with them whether they can provide the injection instead.

Treatment is recommended if it has been confirmed that you have gonorrhoea, there is a high chance you have it, or if your partner has the infection. If you are concerned that you may have contracted this infection you can obtain a gonorrhoea test online through HealthExpress.

Whilst reports develop in the UK, all we can hope is 'Super Gonorrhoea' goes the way of 'Batman V Superman' and ends up being nothing more than over-hyped.


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