The STI Clinic News - Gonorrhoea

Gonorrhoea Research Update

Robert Mackay — Thu, 06 Jul 2017 16:57:19 GMT

In April 2016, gonorrhoea hit the headlines after Public Health England revealed that antibiotic-resistant strains (known as "super-gonorrhoea") had been found in the Midlands and the southeast of the country, after originally being identified in the north. This information was alarming because it suggested the spread of a disease that is becoming harder to treat day by day.

Currently, super-gonorrhoea strains are resistant to the antibiotic azithromycin. A secondary antibiotic, ceftriaxone, is being used in place of azithromycin, but it’s feared that gonorrhoea strains could develop resistance to that as well, leaving doctors unable to treat the infection at all.

With this issue becoming one of the big health scares of the moment, it’s unsurprising that scientists are dedicating more time to looking into the precise mechanisms of the infection. Most recently, researchers at the University of Maryland carried out a study investigating how gonorrhoea bacteria – "Neisseria gonorrhoeae" – are able to penetrate the cells of the cervix in women.

This study was undertaken because the cervix is usually able to shed and dispose of infected cells without compromising the integrity of the cervix lining. It was found that the N. gonorrhoeae bacteria disrupt this normal function, by breaking the tight connections between the cells of the cervix lining and inducing cell shedding; this in turn enables the bacteria to infect the cervix cells. The study indicated that gonorrhoea has this effect upon the cervix lining by provoking the activation of a certain protein.

It isn’t yet known how this study could affect the current medical approach to gonorrhoea, but it’s hoped that this kind of research will, in the future, suggest alternative, safe treatments for antibiotic-resistant strains. Until this kind of treatment has been developed, it’s advised that people take more caution than usual when engaging in sexual activity.

Staying Safe in the Bedroom

The main rules for engaging in safe sex are:

Always use condoms for penetrative sex when you aren’t sure your partner is free from STIs
Never share sex toys without washing them or applying a new condom
Use dental dams for oral sex if you aren’t sure your partner is free from STIs
Don’t engage in sexual contact if you or your partner has any noticeable symptoms (see below)
Get tested if for STIs if you have unprotected sex (e.g. if the condom splits) with someone who may have an infection
Get tested if you develop any symptoms
Get tested regularly if you are having regular sex with new or multiple partners, particularly if you are in the high risk group of men who have sex with men

The above can all be applied to the risks associated with contracting gonorrhoea. This is because gonorrhoea is carried in semen and vaginal fluid, and can be passed on through vaginal, anal and oral sex. It can also be transmitted via unwashed sex toys. Less commonly, gonorrhoea infects the eyes and throat, which is why it can be a good idea to use condoms for oral sex.

The classic symptoms of gonorrhoea can be confused with other STIs such as chlamydia; however, whatever the cause, it’s important to get them checked out. It’s also worth noting that gonorrhoea doesn’t always cause symptoms in its early stages – for that reason, you should get tested if you think you may have been exposed, even if you feel completely healthy.

Gonorrhoea symptoms in women include:

Unusual vaginal discharge that is thin, watery or green or yellow in colour
Pain or a burning sensation when urinating
Pain in the abdomen
Irregular bleeding e.g. after sex, between periods
Heavier periods

Gonorrhoea symptoms in men include:

Unusual white, yellow or green discharge from the penis
Pain or a burning sensation when urinating
Swelling in the foreskin
Pain in the testicles

If you have had unprotected sex with someone displaying the symptoms listed above, or if you are experiencing them yourself, you should get tested for gonorrhoea. You can do this for free at NHS centres; alternatively you can order a home test kit through an online service like The STI Clinic. Click here to learn more.

Super Gonorrhoea Explained

Robert Mackay — Sat, 07 May 2016 12:50:28 GMT

You’ve probably heard the term "super gonorrhoea" being discussed in the news recently. There’s been talk of it since an outbreak in Leeds last September, but more recent reports have reignited the conversation. So what’s the story behind this dramatically named disease, and how at-risk is the average person?

The first thing to know is that super gonorrhoea is not a more aggressive or complicated form of gonorrhoea. The "super" refers to the fact that the bacterial infection is resistant to a certain type of antibiotic, making it far harder to cure. Ultimately, this means that the symptoms of gonorrhoea will progress, potentially leading to more serious complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility in women; and infection in the testicles or prostate in men.

Common gonorrhoea symptoms include unusual discharge from the penis or vagina and pain or a burning sensation when urinating. Men may also experience swelling of the foreskin, and women may experience irregular bleeding. If you are experiencing any of these symptoms, you should get an STI test as soon as possible.

What is antibiotic resistance?

Antibiotic resistance refers to any strain of bacterial infection that can no longer be cured with antibiotics. This is very problematic, as it means life-threatening bacterial infections that have long been treated with antibiotics could suddenly become very difficult to cure.

What causes antibiotic resistance?

When you take a course of antibiotics, it should kill off all the bacterial infection it is targeting. Sometimes, however, the antibiotics do not kill off all the bacteria, and the ones that survive reproduce. This creates a new strain that is slightly more resistant to the antibiotic than that which was killed off.

The key thing to know about antibiotic resistance is that it only refers to bacterial infections, and not to individual people. It is not possible to make yourself resistant to antibiotics, but often this misunderstanding leads patients to stop a course of antibiotics early in an effort to avoid developing a resistance. In actual fact, finishing a course of antibiotics early is one of the things contributing to antibiotic resistance. For this reason, it is crucial always to finish a full course of antibiotics that you have been prescribed.

Antibiotic Resistance in Super Gonorrhoea

In the case of super gonorrhoea, the bacterial infection causing gonorrhoea has developed a resistance to the common antibiotic azithromycin. The theory is that this resistance has partly been caused by people discreetly ordering gonorrhoea treatment over the internet from online pharmacies.

The established treatment for gonorrhoea in the UK is two doses of antibiotics; an injection of ceftriaxone, and a single high dose of azithromycin tablets. When patients order gonorrhoea treatment online instead of going to a doctor, they will be given cefixime tablets as an alternative to the injection. The tablets are not as effective in treating the infection, which puts more of a burden on azithromycin to fight the bacteria, resulting in the gonorrhoea developing a new strain resistant to the azithromycin.

Avoiding Super Gonorrhoea

A recent report by Public Health England showed that there were 34 cases of azithromycin-resistant super gonorrhoea in the UK between November 2014 and April 2016.

The medical community currently thinks that the best way to tackle super gonorrhoea is to focus upon high-risk groups. This includes people who change sexual partners frequently, men who have sex with men, and sex workers. If you fall into one of these groups, it’s important to be rigorous about practising safe sex. That means always wearing condoms when you aren’t sure that your partner is free from sexually transmitted infections.

It’s also important to get tested regularly, which you can do through the NHS or by ordering a home gonorrhoea test kit from us at The STI Clinic.

If you are diagnosed with gonorrhoea, you should not order treatment over the internet unless there really is no alternative in your personal circumstances. Instead, you should go to a sexual health or GUM clinic, or visit your doctor. They will be able to administer the necessary ceftriaxone injection, which will give you maximum protection against the infection.

While it is not advised that you receive gonorrhoea treatment over the internet, it is perfectly safe to get tested through reputable websites, such as this one.

Potential New Gonorrhoea Treatment

Robert Mackay — Thu, 12 Jun 2014 15:29:50 GMT

We have written many times before about how Gonorrhoea is becoming resistant to antibiotic therapy and the race really is now on to find a new medication to deal with this increasingly prevalent STI. Most of the old medications, such a Ciprofloxacin, that were once effective against gonorrhoea are more or less obsolete in terms of being able to treat this particular infection.

AstraZenica, fresh from fighting of the unwanted advances of Pfizer, has been granted a fast track status by the FDA for its new gonorrhoea medication. Astra is keeping tight lipped about its new product but if the product works and is safe, this could be a very much needed new product in the arsenal of new antibiotics that we are going to require to fight infections that have become resistant to the older antibiotics out there.

If someone tests positive for Gonorrhoea then we have to recommend an intramuscular injection of Ceftriaxone along with an oral dose of Azithromycin. If the patient is unwilling or unable to have the intramuscular injection then that element of the therapy can be substituted with Cefixime.

You can get tested for gonorrhoea through this website but using a sample collection kit that is easy to use. We have a test that reports results in under 4 hours if time is important and our standard tests are pretty quick, with next day results and free treatment if you test positive.

Drug Resistant Gonorrhoea

Robert Mackay — Wed, 08 May 2013 08:18:14 GMT

Although we have been aware about the concerns relating to antibiotic resistant gonorrhoea for some time, there has been a new development. The antibiotic resistant gonorrhoea strain, which goes by the name “gonorrhoea HO41”, was initially discovered in a sex-worker in Japan. Although there were some reports recently that the virus had spread outside of Japan, they have now been retracted in mainstream media. To date, the virus has not gone beyond Japan and there are no known cases where an individual has died after contracting the virus.

It was reported recently that the Chief Medical Officer in the UK recommended that the threat from drug resistant gonorrhoea be added to the civil emergencies risk register. In addition to that, several articles in US media recently compared the threat of antibiotic resistant gonorrhoea to the threat AIDS once used to pose. Gonorrhoea is easier to transmit than HIV so there is potentially a greater public health risk.

The main reason for the widespread media reporting on this matter was that experts announced that gonorrhoea HO41 could be considered as a rather aggressive virus, which could potentially kill the infected individual in a matter of days as a result of septic shock. Perhaps it would be helpful if the current reports were put into context along with other research on “super bugs” that may be resistant to treatment (such as such as MRSA). Although there is a steady increase of cases with gonorrhoea HO41 in Japan, when weighing these numbers to the reports on MRSA, the rate of infection is still comparatively low.

Although there is always room for new research to be conducted and for policies to be implemented, it is also clear that simple individual precautions should not be ignored. These include keeping informed about sexually transmitted infections and new viruses, practising safe sex and getting tested when appropriate, such as after a risky event or when you change partners.