You may have seen stories pop up in the news every couple of months or so warning of a ‘super-strain’ of gonorrhoea (VD) that has become resistant to the treatments available. So, is this typical tabloid sensationalism, or is there genuine cause for concern? Joe Holyoake speaks to Dr Gwenda Hughes, head of STI surveillance at Public Health England, to shed light on it.
What is meant when these news stories talk of a ‘super-strain’ of gonorrhoea?
Well, first of all, we tend to shy away from calling it ‘super-gonorrhoea’ as it’s not quite accurate. In England, we treat gonorrhoea with a dual system of drugs – ceftriaxone and azithromycin. Currently, there have been strains recorded which are highly resistant to azithromycin. This is a concern for us if it spreads more widely, as it may gain resistance to ceftriaxone as well. If that happens, then we will probably see treatment failures, as none of the current drugs will work.
However, it’s important to highlight that we have only ever had one case where the strain was resistant to both drugs, but it was eventually treated successfully, though with some difficulty, I must add.
Will there be any new antibiotics to treat it?
We are aware of some drugs that are currently in development that may be able to treat it, but nothing in the immediate future.
Will we see other STIs gain a resistance to anti-biotics?
Yes, it can happen and we have seen that other STIs, such as syphilis, can become resistant to certain anti-biotics, though most of these STIs can still be effectively treated with other antibiotics. We also know that many other infections, not just STIs, gain a resistance to antibiotics, so much so that the World Health Organisation has made tackling antibiotic resistance one of their main priorities. However, the reason we’re particularly worried about gonorrhoea is because it has a long history of developing resistance rapidly and we’re using the last line of drugs to treat it.
How many cases of the high-level resistant strain of gonorrhoea have there been so far?
As of August 2016, there have been a total of 48 confirmed and a further 2 probable cases. Though it was initially recorded in northern England, we are seeing a wider regional spread now, included cases in London and the South East. There have been heterosexual cases recorded and increasing numbers among men who have sex with men.
Is it an international problem, or one consigned to the UK at the moment?
In the UK, we have identified an outbreak of high-level azithromycin resistant strains, but cases have been reported in other countries. We’re recording more cases than other countries, but that may be because it hasn’t been picked up or recorded in other countries. Recently we have heard from our colleagues at the Centre of Disease Control in the United States that they are currently managing an outbreak of high-level azithromycin resistant gonorrhoea in Hawaii.
Are there extra precautions people should be taking?
Well, nothing aside from the advice we already give to avoid gonorrhoea and any other STI for that matter, which is to wear condoms if you’re having sex with a new partner or casual partners. We don’t want to cause undue alarm at this stage, as all of the high-level resistant strains have been treated successfully. However, there is the possibility that we may not have effective treatment for gonorrhoea in future, so we want to emphasise that prevention will be easier than the cure.
And what’s your opinion on the media coverage this has received so far?
Well, the media have a particular slant on it! However, we do welcome the coverage, as it is an important public health concern and we do want to raise awareness. We would like people to be aware that it may not be so easily treatable in the future, so they can protect themselves by using condoms and avoiding infection, as in future it may not be as easily treatable as it currently is.
• For further information on this gonorrhoea, visit the Public Health England website or the Terrence Higgins Trust website (tht.org.uk)
