The report of the first ever case of “super-gonorrhoea” – a bug which is resistant to frontline antibiotics – comes as no surprise to experts in sexually transmitted diseases.
Syphilis, HIV and a relatively new sexually transmitted disease – Mycoplasma genitalium – are also developing resistance to antimicrobial treatments.
On Wednesday, Public Health England announced the world’s worst ever case of super-gonorrhoea, contracted by a British man after a sexual encounter with a woman in South East Asia. The main antibiotic combination failed to cure the infection and doctors are hoping that one final treatment may work.
Infectious disease experts have long warned about the spread of drug-resistant gonorrhoea. A report by the World Health Organization last year revealed that gonorrhoea was becoming much harder to treat, with 77 countries reporting resistance to at least one antibiotic.
In 2016, WHO changed its gonorrhoea treatment guidelines, advising doctors to use a combination of the antibiotics azithromycin and ceftriaxone: this failed to work in the case of the British man and it is why doctors are so concerned. It is the standard treatment for gonorrhoea because so many other drugs have failed over the years.
Olwen Williams, a consultant in sexual health and president of the British Association for Sexual Health and HIV (BASHH), said that this case had serious implications.
“This is a significant development because it shows that the bacteria Neisseria gonorrhoeae has mutated a step further than we were anticipating,” she said.
“If these two drugs aren’t working we have to think what else we can use. One of the other antimicrobials we could use is spectinomycin but that is in very short supply,” she said.
Dr Williams added that it was important to grow the gonorrhoea culture in the laboratory to determine which drugs it should be treated with.
“In some parts of the world they will test for gonorrhoea but will treat it without knowing what the sensitivities are. If you treat it blind – without knowing what it’s resistant to – you can drive an epidemic,” she said.
Peter Greenhouse, a sexual health consultant from Bristol, said that drug resistant infections were becoming a common problem in clinics. He highlighted a relatively new sexually transmitted disease – Mycoplasma genitalium – which was first identified in the 1980s and has developed resistance to antibiotics.
This little-known infection, which some studies have shown to be as prevalent as chlamydia, is rarely diagnosed and tested for. BASHH says the infection, which can lead to infertility in women, “has the potential to become the next superbug within a decade”.
Dr Greenhouse said: “I have had cases of this where I have tried four or five different drugs and then had to source drugs from Australia and Japan. I have had to prescribe drugs I’ve never prescribed in my life.
“Over the next few years it’s going to be enormously troublesome and much more expensive to treat these infections.”
An investigation by the Daily Telegraph earlier found that antibiotic resistance is having a huge impact both in the UK and around the world, as the increase in trade and travel mean that superbugs are spreading globally.
Dr Williams said that she had seen reports on social media that a doctor in Australia had treated a similar case of “super gonorrhoea” imported from Bali.
“So this British case is probably the first to be officially reported,” she said.
The case also means that the bug is circulating in South East Asia without being treated or managed, said Dr Greenhouse.
Resistance to antibiotics is a problem in other sexually transmitted diseases but are not at the same level seen in gonorrhoea. Resistance to HIV drugs, particularly in parts of the developing world, is becoming a concern but there are still alternative treatments.
There have also been reports of resistance to drugs to treat syphilis, numbers of which are currently increasing. There were nearly 6,000 cases of syphilis in 2016, a 12 per cent increase on the previous year’s figure and the largest number since 1949.
Simon Harris, senior staff scientist at the Sanger Institute in Cambridge, said: “Of the major bacterial STIs, only gonorrhoea and Mycoplasma genitalium are particularly problematic in terms of resistance.
“The most common bacterial STI is chlamydia, for which no resistance to first line antimicrobials has been seen in wild isolates. Syphilis does sometimes have resistance to macrolides, but the first line treatment is usually penicillin, against which no resistance has been reported.
Dr Greenhouse warned that cuts to sexual health services would fuel the rise in sexually transmitted diseases. A report by the Kings Fund last year found that a quarter of local authorities in England – 36 – had cut sexual health services.
“At the same time that antibiotics are failing to treat some of the most important infections the government decides to close a sizable proportion of sexual health clinics,” he said.
Nick Thomson, professor of microbiology at the Sanger Institute in Cambridge, said that gonorrhoea is a particular problem as it becomes resistant to drugs fairly quickly. But he said that human behaviour was the biggest factor in the rise of sexually transmitted diseases.
“We have apps on our phones which help us to find people – the rules have changed. But one thing that hasn’t changed is that bacteria are very good at spreading, given the right opportunities. So if we change our behaviour there will always be a bacteria or infection that profits from that change,” he says.
He also said that travel to other countries was fuelling the spread.
“People don’t realise that they could go on holiday to Australia, pick something up, bring it back and then cause an epidemic in the UK,” he said.