Public Health England (PHE) released statistics in July showing that infection rates of gonorrhea in England has risen sharply in recent years.
Between 2012 and 2015, the incidence of gonorrhea in the country rose by 53%, from 26,880 to 41,193 cases. Most notable was a rise among gay and bisexual men.
Even more concerning was the appearance of so-called ‘super gonorrhea’ – a variation of the bacterium that is resistant to traditional antibiotic treatment.
This first appeared in straight people but was soon identified in a handful of gay men, were it has spread more quickly.
The first outbreak was among gay men in Leeds, but it has since appeared in the Midlands and further south – with five reported cases in London.
But what exactly is it and what happens if you become infected with it?
What is ‘super gonorrhea’?
Basically, it’s a slightly different variation of the gonorrhea bacterium. This is a sexually-transmitted infection that can infect your penis, vagina, rectum or throat. It’s been dubbed ‘super gonorrhea’ by the media, but this may inadvertently give the impression that it’s an all-conquering, impossible-to-treat version.
This is not the case. Until now, gonorrhea infections in the UK are treated with a two-pronged attack of antibiotics given at the same time: ceftriaxone and azithromycin.
This new outbreak of gonorrhea has a high level of resistance to azithromycin. In other words, the antibiotic is largely ineffective against it. Instead, the reported infections have had to be treated with ceftriaxone only.
So far, all reported cases – and we are still talking about a fairly small number (34) – have been successfully treated. Of course, there are probably people who are infected but do not yet know.
How do you know if you’re infected?
Both common gonorrhea and ‘super gonorrhea’ presents themselves in exactly the same way. This can include sharp pain when urinating and an unpleasant greenish or yellow pus-discharge from your penis or vagina. It can be a sore throat if infected in your throat.
Alternatively, you can have no symptoms – particularly if you are only infected in your throat or rectum. A definite diagnosis can only be given through a check-up with an sexual health clinic.
So if it can be treated with the other antibiotic, what’s the problem?
Health officials are concerned that it the bacterium has developed a resistance to one antibiotic then it may evolve to develop resistance to ceftriaxone too. If that happens, we really could have a major health problem – one that doctors are unsure how they would handle.
A spokesperson for PHE, asked by GSN how someone with gonorrhea would be treated if it were resistant to both antibiotics, simply replied: ‘Management of future cases of treatment failure will be done on a case by case basis, involving expert advice from doctors and scientists.’
If I don’t have any symptoms, is it important to get treated?
Yes. Any untreated infection with gonorrhea can lead to severe chronic complications, including pelvic inflammatory disease, ectopic pregnancy and infertility, among others things.
Is there anything I can do to protect myself?
‘PHE actively monitors, and acts on, the spread of antibiotic resistance and potential gonorrhea treatment failures and has introduced enhanced surveillance of identified cases, their sexual partners and treatment,’ says Dr Gwenda Hughes, Consultant Scientist and Head of the Sexually Transmitted Infections Section at Public Health England.
‘This will help ensure cases are managed promptly and reduce the spread of resistant strains.’
‘However our advice remains the same; it is far better to avoid getting or passing on gonorrhea in the first place and everyone can significantly reduce their risk by using condoms with all new and casual partners.’
I already use condoms for anal sex – they don’t mean oral sex too, do they?
Yes, they do. ‘Condom use is also advised for oral sex to prevent STIs such as gonorrhea and syphilis, which are commonly spread through oral sex,’ clarified a PHE spokesperson.
Given that an increasing number of gay men are not using condoms for anal sex, many believe the chances of persuading them to use condoms for oral sex are pretty remote – particularly when ‘super gonorrhea’ can be treated with ceftriaxone and the number of reported cases is still relatively low.
It’s a reality acknowledged by the head of UK-based men’s health charity GMFA.
‘If you want to prevent the risk of getting an STI you should wear a condom for oral sex, Ian Howley told GSN.
‘We understand that the majority of gay men don’t use condoms for oral sex. However, you may be vulnerable to other STIs this way, such as chlamydia, gonorrhea, herpes and syphilis. This is because all of these STIs are much more infectious than HIV.
‘As most men choose not to wear a condom for oral sex, it’s advisable to have a regular sexual health check-up to ensure that any infections you may pick up can be detected and treated quickly.
‘At GMFA we recommend that all gay men get tested for HIV and STIs at least once a year. However you should be testing more frequently if you are having sex with multiple partners.’
As an interesting side note, just last week reports emerged of a study that found simple antiseptic supermarket-bought mouthwash can significantly reduce the amount of gonorrhea in the throat of someone infected.
However, the author of the study says more research is needed to determine whether standard mouthwash can play a role in tackling gonorrhea throat infections or protecting people from infection.
Until then, getting a regular sexual health check-up, even if you have no symptoms, is highly recommended. This is particularly the case if you’ve had several sexual partners in recent weeks or months.