A cure for so-called ‘super gonorrhoea’ may be on the horizon following a scientific breakthrough.
Australian researchers have today discovered how the common STI dodges the body’s immune system.
The study could lead to a new treatment to kill the bug, which is rapidly becoming resistant to last-ditch antibiotics.
It follows the case of an Englishman, reported earlier this week, who caught a strain of gonorrhoea branded the ‘world’s worst’.
Health officials warned the two most common types of antibiotic given to patients with gonorrhoea were powerless and failed to banish the STI.
Australian researchers have today discovered how the common STI dodges the body’s immune system and becomes resistant to antibiotics
The man – who was having regular sex with a woman in the UK – picked it up during a one night stand in South-East Asia earlier this year.
Public Health England declared it as the first recorded case of the STI being resistant to ceftriaxone and azithromycin – the recommended treatment.
The new breakthrough, made by Monash University researchers, offers hope of a cure amid a surge in cases of antibiotic-resistant gonorrhoea.
The scientists discovered super gonorrhoea, which can make women infertile if untreated, makes the body’s immune cells commit ‘suicide’.
Dr Thomas Naderer, senior author, said it provides a new understanding of how gonorrhoea bacteria cause the death of immune system cells.
He added: ‘This may lead to strategies to combat gonorrhoea infection and its symptoms.’
WHAT IS SUPER GONORRHOEA?
When gonorrhoea is resistant to one of two antibiotics recommended to treat it, it is known as super gonorrhoea.
But the case of an Englishman whose STI was resistant to azithryomycin and ceftriaxone is the first recorded case where the bug has fought off both treatments.
All types of gonorrhoea – historically called ‘the clap’ – are caused by the bacteria Neisseria gonorrhoeae.
It is quick to develop and strains mutate every few years to become resistant to drugs.
Doctors have frequently changed their recommended treatments to keep up with the changing nature of the bug. It stopped responding to penicillin in the 1980s.
Symptoms of gonorrhoea include discharge, bleeding or pain when urinating.
But around one in two women and one in 10 men will not experience any signs, which is why the infection is so easily spread.
Women who do not get treatment can develop pelvic inflammatory disease – an infection of the womb and ovaries which can cause infertility.
In pregnancy, it can cause miscarriage, premature birth or lead to babies developing problems with their vision.
Patients with super gonorrhoea can be given some other treatments which might work but can have unpleasant side effects.
Health experts warn it is only a matter of time before the bug mutates to resist these remaining antibiotics too. They recommend using condoms and regular testing to prevent spread of the disease.
The study looked at the superbug version of gonorrhoea, which is extremely small, and found it creates even smaller membrane-bound sacs to attack immune cells.
Filming the microscopic superbug, the scientists saw these sacs trigger suicide in the cells which ordinarily kill foreign invaders like bacteria.
Without them, the gonorrhoea is able to flourish, researchers wrote in the journal PLOS Pathogens.
Gonorrhoea, which was historically called ‘the clap’, causes discharge, bleeding or pain when urinating. It is symptomless in many people and is the third most common STI in the UK.
Fears over the super version of the STI began when it swept across Britain in 2016, with cases confirmed in London, West Yorkshire, the West Midlands and North East.
But these cases involved a form of gonorrhoea which just one course of tablets, of the antibiotic azithromycin, was unable to treat.
The new English patient, whose name and location have been withheld by health officials, cannot be treated with that antibiotic or ceftriaxone.
It means he now needs daily injections with another form of antibiotic, which is less commonly used, and is being closely monitored by health officials.
It is unclear whether the British man caught super gonorrhoea from the woman he slept with in Asia, or if it mutated to become antibiotic-resistant.
Chief Medical Officer Dame Sally Davies has previously warned antibiotic resistance is a threat as severe as terrorism.
The fear is that further antibiotics, including several last-resort drugs, will be overcome by super gonorrhoea as it evolves.
The new study provides hopes of an alternative solution, opening up the way for therapies that prevent the immune system being overwhelmed by allowing the body’s natural defences to kill the bug.
WHAT ARE THE SYMPTOMS OF GONORRHOEA?
More than 35,000 people a year are infected with gonorrhoea in England, including record numbers of baby boomers. Only chlamydia and genital warts are more prevalent.
Figures show 78 million people worldwide contract gonorrhoea, which can often go symptomless for weeks, each year.
Symptoms usually strike within two weeks of infection – but can stay hidden for many months.
In women, symptoms of gonorrhoea can include:
- an unusual vaginal discharge, which may be thin or watery and green or yellow in colour
- pain or a burning sensation when passing urine
- pain or tenderness in the lower abdominal area (this is less common)
- bleeding between periods, heavier periods and bleeding after sex (this is less common)
In men, symptoms of gonorrhoea can include:
- an unusual discharge from the tip of the penis, which may be white, yellow or green
- pain or a burning sensation when urinating
- inflammation (swelling) of the foreskin
- pain or tenderness in the testicles (this is rare)
Source: NHS Choices
A PHE report read: ‘This is the first global report of high-level azithromycin resistant N. gonorrhoeae which is also resistant to ceftriaxone.’
It added that it has now ‘formed an incident management team’ to co-ordinate the investigation and contain the spread of the superbug.
The new case, revealed yesterday, follows repeated warnings over the dangers of super gonorrhoea by concerned health chiefs.
WHO raised concerns two years ago that the STI, once known as the ‘clap’, could become immune to antibiotics in a ‘matter of years’.
COULD THIS BE A CURE FOR SUPER GONORRHOEA?
A new antibiotic was found in the ‘arms race’ against incurable superbugs, The Daily Mail revealed last July.
The drug is a weapon in the fight against a strain of ‘super-gonorrhoea’ similar to that which swept across London, the South East and Midlands.
Chief Medical Officer Dame Sally Davies has previously written to GPs warning that gonorrhoea, Britain’s second most common STI after chlamydia, could become an ‘untreatable disease’.
But the bug, some strains of which are now resistant to every hospital antibiotic, was defeated by British scientists using the antibiotic closthioamide.
While still at least five years away from being available to patients, closthioamide cured 98 per cent of gonorrhoea samples taken from British patients.
The antibiotic, only discovered seven years ago, has also been found to tackle hospital superbug MRSA and deadly E.coli and could go on to be tested against other bacteria, including drug-resistant TB.
The new document stated the man – whose location has also been withheld – attended sexual health services earlier this year.
He was having regular sex with a female in the UK, but also had a one-off encounter with another woman in south-east Asia.
The man told doctors his gonorrhoea symptoms began a month after having sex with the woman on his travels, PHE officials said.
The document does not state whether the Asian woman already had the multi-drug resistant strain of gonorrhoea, or if it mutated.
He was started on a course of ceftriaxone and spectinomycin – but tests showed the STI remained in his throat, suggesting one failed to work.
Laboratory tests revealed a high resistance to azithromycin and ceftriaxone. It also showed the bug was only susceptible to spectinomycin.
The patient – who will be retested in the middle of next month to see if he still has gonorrhoea – is now being treated with daily injections of ertapenem, another antibiotic.
Preliminary STI results for his sexual partner in the UK returned negative for gonorrhoea. She is being followed up.
More than 35,000 people a year are infected with gonorrhoea in England, including record numbers of baby boomers. Only chlamydia and genital warts are more prevalent. Figures show 78 million people worldwide contract gonorrhoea each year.
But a ‘super’ version of the STI, which is caused by the Neisseria gonorrhoeae bacterium, swept across Britain two years ago, striking London, the South East and the Midlands.
It was resistant to the common antibiotic ciprofloxacin and extended-spectrum cephalosporins, which are the drugs of last resort.
A WHO analysis of STI data around the world previously revealed 97 per cent of countries have reported strains of gonorrhoea that are resistant to ciprofloxacin.
A further 81 per cent stated there was increasing resistance to just azithromycin. And more than 50 countries warned strains were showing some form of resistance to ceftraixone – another last-resort treatment.
Chief Medical Officer Dame Sally Davies has previously written to GPs warning that gonorrhoea could become an ‘untreatable disease’.
Super gonorrhoea is one of many antibiotic-resistant infections which together kill an estimated 700,000 people worldwide each year.
Deemed to be one of the biggest threats to humanity, the issue has previously been cited as severe as terrorism and global warming.
Antibiotics have been so overused by GPs and hospital staff for decades that the bacteria have evolved to become resistant.
Doctors claim medicines including penicillin no longer work on sore throats, skin infections and, more seriously, pneumonia.
Dr Gwenda Hughes, head of STIs at PHE, said: ‘We are investigating a case who has gonorrhoea which was acquired abroad and is very resistant to the recommended first line treatment.
‘First line treatment for gonorrhoea is a combination of two antibiotics (azithromycin and ceftriaxone). This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.
‘We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimised.’