Super-Gonorrhea: A YEP Crew Blog Post (2018)

April 27, 2018

Two Australians have recently contracted cases of ‘super-gonorrhoea’ only a month after Public Health England announced the world’s “worst ever” case of super-gonorrhoea.2 Which means that the antibiotic crisis has already landed on our shores.

What is gonorrhoea?

The sexually transmitted bacteria Neisseria gonorrhoeae can cause unpleasant symptoms and can lead to infertility. It’s also the second most common sexually transmitted infection (STI) in Australia.3 Gonorrhoea is transmitted through unprotected vaginal, anal or oral sex and can infect the genitals, throat or rectum. It can also be passed from an infected pregnant woman to their child during childbirth. Gonorrhoea can be asymptomatic, or it can cause a variety of symptoms shown in Figure 2.4 However, this infection is one that we have become accustomed to easily treating with a simple course of antibiotics.

What is super-gonorrhoea?

Super-gonorrhoea isn’t the superhero of STIs. In fact, to us it’s more of a supervillain. The term describes the bacteria Neisseria gonorrhoeae that has become resistant to antibiotics.2 Increasingly, we are unable to treat highly resistant strains of gonorrhoea with recommended antibiotic therapies. This means that patients may be stuck with a persistent gonorrhoeal infection or even contribute to the continued spread of super-gonorrhoea if they don’t use protection during sex.5

How does gonorrhoea become super-gonorrhoea?

Super-gonorrhoea develops through the process of antibiotic resistance shown in Figure 1. 5Figure 1. How super-gonorrhoea develops.

This problem is made worse when the course of antibiotics is not completed and results in two dangers.

  1. The infection will reoccur and will be more difficult to treat.
  2. Some of the bacteria causing the infection may survive and be passed on to other people, and these will be the bacteria with the greatest resistance to antibiotics (a form of artificial selection).

Once a colony of gonorrhoea is unable to be treated with the recommended dual antibiotic therapy of Ceftriaxone and Azithromycin or other common antibiotics it is called ‘super-gonorrhoea’.6

The future without antibiotics

Gonorrhoea isn’t the only bacteria becoming highly resistant to antibiotics. Other bacterial STIs are developing resistance, but it’s not yet at the same concerning level seen in super-gonorrhoea.5 Antibiotic misuse and overuse has also contributed to the development of many strains of resistant bacteria. If we continue down the current course, we may not be able to treat common and everyday infections which will result in many deaths and an inability to provide safe surgeries.6

How do you know if you have gonorrhoea?

If you have had unprotected sex with any number of sexual partners since your last STI test you may be infected with gonorrhoea. Symptoms of gonorrhoea differ between men and women, but often there are no obvious signs. That’s why you should always get tested if there’s a chance you might have an STI!7

Figure 2. Symptoms of gonorrhoea.

What happens if you don’t get treated or you are infected with super-gonorrhoea?

Untreated gonorrhoea can cause many serious and permanent health issues in males and females, whether this is due to a lack of testing, treatment or infection with untreatable super-gonorrhoea.

In women, untreated gonorrhoea can lead to pelvic inflammatory disease (PID), which can cause:8

  1. Formation of scar tissue that blocks the fallopian tubes (which connects the ovaries to the uterus)
  2. Ectopic pregnancy, which is a pregnancy that occurs outside the womb, such as in the fallopian tubes. This can be life threatening to the mother, and is almost always terminated.9
  3. Infertility, which is the inability to become pregnant.
  4. Long-term pelvic or abdominal pain.

In men, untreated gonorrhoea can lead to epididymitis, which is inflammation of the tubes leading from the testicles to the vas-deferens, and is a painful condition which can rarely result in sterility.10

Having untreated gonorrhoea may increase your risk of contracting HIV during unprotected sex. It can also rarely spread to your blood or joints.4

Treatment

  1. Diagnosis of gonorrhoea involves a simple non-invasive urine test.
  2. First-line treatment of Gonorrhoea consists of two antibiotics Azithromysin and Ceftriaxone – used together to try and slow down the development of antibiotic resistance.11
  3. Your doctor will also ask you about people you have had unprotected sex with so that they can also get tested, this is called ‘contact tracing’.12

Prevention

  1. Use condoms or dams with water or silicone-based lubricant
  2. Start an open conversation about practicing safer sex, STIs and other sexual partners BEFORE you start having sex!
  3. Get regular STI tests from your GP or a drop in sexual health clinic

How can you help

  • Prevent infection from STIs using condoms, dams and talking openly about sexual health
  • Get Tested! You should get tested every year and after having unprotected sex, gonorrhoea symptoms, a partner who has tested positive for an STI or a change in partner.
  • Use Antibiotics Correctly: if you are prescribed a course of antibiotics, used them as instructed by your doctor. That usually means finishing every pill, even if symptoms go away!

Find out more

GET the Facts – WA Department of Health:

https://www.getthefacts.health.wa.gov.au/sex-infections/gonorrhoea

SHQ (Sexual Health Quarters) Drop in Clinic:

https://shq.org.au/

References

  1. Hoffman J. Super Gonorrhoea [Internet]. 2018 [cited 25 April 2018]. Available from: https://www.thrillist.com/health/nation/super-gonorrhea-symptoms-treatments-and-how-to-avoid-it
  2. Multi-drug resistant gonorrhoea [Internet]. Health.gov.au. 2018 [cited 25 April 2018]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr18-dept-dept004.htm
  3. Annual Surveillance Report on HIV, viral hepatitis and STIs in Australia 2017 | UNSW – The Kirby Institute for infection and immunity in society [Internet]. Kirby.unsw.edu.au. 2017 [cited 25 April 2018]. Available from: https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-and-stis-australia-2017
  4. Torpy J, Lynm C, Golub R. Gonorrhea. JAMA. 2013;309(2):196.
  5. Ventola C. The antibiotic resistance crisis: Part 1: Causes and threats. P & T : a peer-reviewed journal for formulary management [Internet]. 2015 [cited 25 April 2018];40(4):77-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25859123
  6. Ndowa F, Lusti-Narasimhan M. The threat of untreatable gonorrhoea: implications and consequences for reproductive and sexual morbidity. Reproductive Health Matters. 2012;20(40):76-82.
  7. Gonorrhoea symptoms [Internet]. Healthdirect.gov.au. 2018 [cited 25 April 2018]. Available from: https://www.healthdirect.gov.au/gonorrhoea-symptoms
  8. Trent M, Das B, Ronda J. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infection and Drug Resistance [Internet]. 2016 [cited 25 April 2018];Volume 9:191-197. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998032/
  9. Danielsson K. Can the Baby Be Saved in an Ectopic Pregnancy? [Internet]. Verywell Family. 2018 [cited 25 April 2018]. Available from: https://www.verywellfamily.com/can-an-ectopic-pregnancy-be-saved-2371464
  10. Hedger M, Meinhardt A, Michel V, Pilatz A. Epididymitis: revelations at the convergence of clinical and basic sciences. Asian Journal of Andrology [Internet]. 2015 [cited 25 April 2018];0(0):0. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4577585/
  11. Unemo M, Workowski K. Dual antimicrobial therapy for gonorrhoea: what is the role of azithromycin?. The Lancet Infectious Diseases. 2018;18(5):486-488.
  12. Contact tracing [Internet]. Ww2.health.wa.gov.au. 2015 [cited 25 April 2018]. Available from: http://ww2.health.wa.gov.au/Silver-book/Contact-tracing-managing-sex-partners
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