New super-gonorrhoea cases in UK spark track-and-trace investigation

Three new cases of antibiotic-resistant gonorrhoea have been reported by the UK Health Security Agency.

The first case of super-gonorrhoea in England, so called because it is resistant to antibiotics, was detected in 2016 and since then there have been a total of 12 cases, including the latest three in 2022.

Experts fear the resistant strain of the bacterium Neisseria gonorrhoeae, which has been detected in at least seven countries and can cause a wide range of long-term health problems, now has a proper foothold in Britain.

A woman in her 20s in London and a heterosexual couple in their 20s based in the Midlands were diagnosed with the strain, which could not be treated with the main antibiotic ceftriaxone.

Further public health investigations are under way but there are currently no known connections between the cases in London and the Midlands.

Dr Katy Sinka, sexually transmitted infection (STI) section head at UKHSA, said: “After a couple of years without any cases of this hard to treat form of gonorrhoea, we have now seen four cases in the last two months. It’s too soon to say whether this will be the start of a longer-term trend, but we do know that STIs are on the rise in general.”

Prof Tim Walsh, an academic lead on antimicrobial resistance at the University of Oxford, said antibiotic resistance to STIs present a “whole array of problems”.  

“We’re running out of drugs that we would treat [resistant infections] with,” he said. At that point, patients require more intensive care in hospitals.

The bacteria is “highly adaptable” and has become resistant to all antibiotics thrown at it, microbiologist Dr David Powell warned. “We’re now just cycling through them,“ he said.

The World Health Organisation (WHO) estimates that 82.4 million people were newly infected with gonorrhoea in 2020.

While gonorrhoea is not life-threatening, it can cause long-term health problems such as pelvic inflammatory disease, infertility and ectopic pregnancies. 

Treating super-gonorrhoea can also be a significant economic burden on health services. In 2018, a British man was only cured after three days of intravenous treatment with antibiotic ertapenem.

In January, the UK Health Security Agency also warned of a rise in cases of extremely antibiotic-resistant shigella, which causes diarrhoea, stomach cramps and fever. Forty-seven cases were detected between September and January, compared to 16 cases in the 17-month period the previous year.

Untreated shigella can cause the colon to rupture and cause peritonitis, a life-threatening condition requiring emergency surgery.

The WHO warned that it has also seen reports of antibiotic resistance to syphilis and mycoplasma genitalium. But, it said, “monitoring resistance in these STIs is not being done”.

Dr Sinka said: “Getting an STI isn’t as simple as taking some medicine and moving on with your life – if not properly treated they can have long-term impacts on your and your partner’s health. Adding antibiotic resistance into the mix makes the impact on your life even greater.”

Overall, NHS data in 2020 shows that more than 135 cases of antibiotic-resistant infections were being detected in hospitals every day – a rise of about 30 per cent over five years.

Despite the increasing need for new antibiotics, there is little incentive for pharmaceutical companies to invest in their development. Antibiotics can take 10-15 years to develop and cost over $1.5 billion, while average revenue is estimated at around $46 million a year.

The new cases come amid an anticipated STI backlog caused by the pandemic.

Public Health England warned that the disruption in sexual health services during lockdowns led to fewer diagnosis. Compared to 2019, consultations at sexual health services in 2020 decreased by 10 per cent. The biggest drop occurred in face-to-face consultations which fell by 35 per cent since 2019, though internet consultations doubled.

Dr Emma Harding-Esch, an epidemiologist of sexual health at the London School of Hygiene and Tropical Medicine, pointed to the Natsal-Covid study which found some individuals, like younger and risky sexual behaviour populations, reported difficulties in accessing STI services in 2020.

She said: “Antimicrobial resistance is one of the biggest challenges to STI control”. 

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