A superbug strain of gonorrhea has developed, making it at risk of becoming untreatable, England's chief medical officer warns. The warning comes after a sudden rise of drug-resistant gonorrhea infection cases.

Dame Sally Davies wrote to all physicians and pharmacies to ensure that they prescribe the appropriate drug to patients with sexually transmitted infections (STIs), specifically gonorrhea. If doctors prescribe only one antibiotic rather than the needed two drugs, the infection won't be resolved and the disease can develop a resistance to the antibiotic the patient has taken.

"Gonorrhea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance," Davies wrote.

"Gonorrhea has rapidly acquired resistance to new antibiotics, leaving few alternatives to the current recommendations. It is therefore extremely important that suboptimal treatment does not occur," she added.

The strain, which is resistant to the first-line antibiotic azithromycin, was first detected in Leeds, North England, in March. Up to date, a total of 16 cases were reported by Public Health England (PHE) and the British Association for Sexual Health and HIV (BASHH).

Twelve of the cases were reported in Leeds and the rest were from Scunthorpe, Macclesfield and Oldham.

What Is Gonorrhea?

Gonorrhea is a sexually transmitted infection involving the bacterium Neisseria gonorrhoeae (N. gonorrhoeae). It infects the mucous membranes of the reproductive tract of both men and women. It can also infect the mucous membranes of the mouth, throat, eyes and rectum. Those infected often don't show symptoms, or the infection appears to be another disease.

Symptoms in women appear within a month, often two to 10 days after exposure, and can include a greenish yellow or whitish discharge from the vagina, lower abdominal or pelvic pain, burning when urinating, conjunctivitis, spotting after intercourse or between periods, burning in the throat and swollen glands.

Symptoms in men appear one to 14 days after infection and can include a greenish yellow or whitish discharge from the penis, burning when urinating and burning in the throat, swollen testicles and swollen glands.

In England, gonorrhea is the third most common STI next to chlamydia and genital warts. Out of the 439,243 new diagnoses in 2014, the most commonly diagnosed STI was chlamydia, with 206,774 diagnoses, genital warts with 70,612 and gonorrhea with 34,958.

With the overall decrease of 0.3 percent of STI cases in England between 2013 and 2014, gonorrhea cases increased by 19 percent. In 2013, there were only 29,419 cases reported.

High proportions of cases were seen in young heterosexuals below 25 years old and in men who have sex with men.

Importance Of Proper Medication

Usually, the recommended drugs prescribed to patients with gonorrhea are a combination of an injection of ceftriaxone and an azithromycin tablet. The BASHH reports that some online pharmacies offer just the oral medication.

Medicating a person with just one antibiotic won't treat the infection and the bacteria will become resistant to that drug, making it harder to cure. Without proper treatment, gonorrhea may lead to severe complications and long-term health issues, including septicemia, infertility and pelvic inflammatory diseases in women. Pregnant women with gonorrhea may give birth to babies with severe eye problems that may lead to permanent blindness.

Public Health England Initiates Investigation

"Investigations are ongoing into a number of cases of anti-microbial resistant gonorrhea," said Dr. Andrew Lee, consultant in communicable disease control at PHE.

He said that affected patients were treated effectively with alternative antibiotics. Since N. gonorrhoeae can mutate and develop resistance, the PHE will continue to monitor and implement measures to prevent the spread of the drug-resistant bacteria. This will help reduce possible gonorrhea treatment failures.

"Individuals can significantly reduce their risk of any STI by using condoms with all new and casual partners and getting tested regularly," he added.

PHE Recommendations

In its Health Protection Report updated in June, the PHE recommended that prevention efforts should include ensuring accessibility of sexual health services.

It added that STI screening tests should be focused on high-risk groups, including sexually active individuals below 25 years old. STIs can be prevented by "consistently and correctly" using condoms until partners are tested.

Photo: National Institute of Allergy and Infectious Diseases (NIAID) | Flickr 

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