Doctors have found a new ‘superbug’ form of gonorrhoea’ that is resistant to a range of antibiotics, it has been announced. Several newspapers have reported on the first case of the strain, which was recently discovered in a Japanese woman. Testing has shown that the strain has resistance against a range of antibiotic drugs, including those commonly used to cure the sexually transmitted infection (STI).
The strain, called H041, was investigated by a Swedish research team lead by Dr Magnus Unemo from the Swedish Institute for Infectious Disease Control. Dr Unemo reportedly told the Daily Mirror that “the drug resistant strain could spread around the world in 10 years”. Researchers are now trying to understand why this strain is resistant to existing treatments and how to stop it from spreading.
Details of the new strain are being presented at a conference of the International Society for Sexually Transmitted Disease Research. Further research into H041 is sure to follow. While UK strains can currently be treated, this news highlights the importance of practising safer sex, such as using condoms. While antibiotics currently provide an effective treatment for gonorrhoea infections, condoms are effective at preventing new infections in the first place.
What exactly is gonorrhoea?
Gonorrhoea is a sexually transmitted infection caused by a bacteria called Neisseria gonorrhoeae. The bacteria can cause unpleasant discharge from the penis and vagina. It can be passed on to others through sexual contact and sharing sex toys (if not washed or not covered with a new condom each time). The bacteria can also live in other areas of the body, including inside the cells of the cervix, the urethra (the tube where urine comes out), the rectum, the throat and, very occasionally, the eyes.
Symptoms of gonorrhoea will usually show up within two weeks of being infected, although sometimes they will not show up until months after a person has become infected. However, about 10% of infected men and 50% of infected women have no obvious symptoms, meaning it may go untreated for some time.
Women may have an unusual discharge from the vagina that may be green or yellow in colour, as well as pain when passing urine. Other symptoms for women may include pain or tenderness in the lower abdominal area and bleeding between periods, although these are less common. Men may have a discharge from the penis which may be green, yellow or white in colour. They may also have pain on passing urine, inflammation of the foreskin or (in a small proportion of cases) pain and tenderness of the testicles or prostate gland.
How would gonorrhoea normally be treated?
Gonorrhoea is unlikely to go away without treatment, and it is better to treat the condition as early as possible. Gonorrhoea is treated with a single dose of antibiotics, based on the local reported susceptibility of the organism and the site of infection. Usually one of the following antibiotics are tried:
These are taken either in pill form or by an injection. Azithromycin and sometimes ciprofloxacin are used if the organism is sensitive. Other antibiotics such as penicillin and tetracycline are not used as strains of gonorrhoea have become resistant to these.
What is different about this new strain?
Testing of the new H041 strain has revealed that it is resistant to ceftriaxone, one of the three preferred antibiotic treatments. Analysis at the Swedish Reference library for Pathogenic Neisseria also found it to be resistant to all other types of cephalosporins (a class of antibiotic that includes Cefixime), as well as the majority of 30 antimicrobials tested. The researchers were able to show that the new bacteria strain possessed a new gene variant that enabled it to be resistant to cephalosporins.
There have been no reported cases of this strain of gonorrhoea in the UK, but the Health Protection Agency has an ongoing surveillance programme to detect cases of antibiotic resistant gonorrhoea should they arise in the UK. This surveillance programme regularly examines samples from a number of genito-urinary medicine (GUM) clinics to monitor how well the samples from attendees respond to different antibiotics.
How is this new strain treated?
Currently, it is not known how best to treat this new strain, although The Independent reported that the Japanese case was cured after a second course of the same antibiotic. It is possible that alternative combinations of drugs and higher doses of current antibiotics may cure infections with the strain. Data in the conference abstract stated that laboratory testing had found that H041 was 4-8 times more resistant to ceftriaxone than other strains of this bacteria.
The researchers say that it is crucial to monitor the spread of antibiotic-resistant gonorrhoea. Ultimately, new drugs will need to be developed to treat it. As with all strains of gonorrhoea and STIs, prevention is better than cure, and it is important to take steps such as using a condom when having sex in order to reduce the transmission of infections.
Does this mean I can’t be treated if I catch it?
Dr David Livermore, director of the antibiotic resistance monitoring laboratory at the Health Protection Agency in the UK, has said that the cephalosporin antibiotics used are still effective for treating gonorrhoea.
However, it is important to prevent this new strain from Japan from spreading further. Careful use of condoms with new sexual partners is important to prevent the spread of all types of gonorrhoea. As the infection can be symptomless the only way to know if you have gonorrhoea is to be tested. Testing is straightforward for both men and women: men are usually tested using a urine sample, whereas women are tested using a swab from the cervix. Testing can either be performed by a person’s GP or they can attend a sexual health clinic, also known as a genito-urinary medicine (GUM), clinic. When visiting a GUM clinic, a person’s details will not be passed on to their GP unless they request it.