Officials in England are advising the public to practice safe sex in light of  an increase in antibiotic resistant cases of gonorrhea, saying it’s a further sign of the very real threat of antibiotic resistance to our ability to treat infections.

Neisseria gonorrhoeae/CDC
Neisseria gonorrhoeae/CDC

Public Health England (PHE) continues to monitor and investigate gonorrhea cases that are highly resistant to the antibiotic ‘azithromycin’. Cases first emerged in the north of England in November 2014. Microbiologists and sexual health doctors in England are being notified that since September 2015 further cases have been confirmed in the West Midlands and in the South of England.

This takes the total number of cases confirmed in England, between November 2014 and April 2016, to 34.

The current outbreak strain remains sensitive to the other drug used in first line therapy, ceftriaxone, meaning this drug is effective in treating these cases. However, if azithromycin becomes ineffective against gonorrhea, there is no ‘second lock’ to prevent or delay the emergence of ceftriaxone resistance, and gonorrhea may become untreatable. The recent increase shows the very real threat of antibiotic resistance, and the importance of monitoring resistance to maintain treatment options, and promoting safe sex to prevent gonorrhea.

Dr Gwenda Hughes, Consultant Scientist and Head of the Sexually Transmitted Infections (STI) Section at PHE, said:

We continue to maintain an enhanced level of surveillance to identify and manage cases of high-level azithromycin resistant gonorrhea. Since September 2015, 11 cases have been confirmed in the West Midlands and in the South of England, 5 of which were in London. Cases to date have been confirmed in both heterosexual men and women and in men who have sex with men.

Fortunately, the current outbreak strain can still be treated with ceftriaxone. Nonetheless, we know that the bacterium that causes gonorrhea can rapidly develop resistance to other antibiotics that are used for treatment, so we cannot afford to be complacent. If strains of gonorrhea emerge that are resistant to both azithromycin and ceftriaxone treatment options would be limited as there is currently no new antibiotic available to treat the infection.

It would be far better to avoid getting or passing on gonorrhea in the first place. Everyone can significantly reduce their risk by using condoms with all new and casual partners.

PHE will continue to monitor, and act on, the spread of antimicrobial resistance and potential gonorrhea treatment failures, to make sure they are identified and managed promptly. It is important that clinicians treating patients with gonorrhea follow the national guidance.