Gonorrhoea is at risk of becoming an untreatable disease, England’s chief medical officer has said.
Dame Sally Davies has written to all GPs and pharmacies to ensure they are prescribing the correct drugs after the rise of a highly drug-resistant strain of the infection.
The warning comes after a national public health alert was triggered in September by an outbreak of highly drug-resistant gonorrhoea in the north of England.
“Gonorrhoea is at risk of becoming an untreatable disease due to the continuing emergence of antimicrobial resistance,” Davies writes.
“Gonorrhoea 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.” The letter is also signed by the chief pharmaceutical officer, Dr Keith Ridge.
At least 16 cases of “super-gonorrhoea” have been detected by Public Health England (PHE) since March, the British Association for Sexual Health and HIV reported in September.
The strain, which is resistant to the first-line antibiotic azithromycin, was first reported in Leeds in March and has spread, with cases reported in patients from Macclesfield, Oldham and Scunthorpe. All of the cases were reported to involve heterosexual patients, and some people have reported partners from other parts of England.
The EU’s infectious diseases monitor has been warning about the growing threat of drug-resistant gonorrhoea for some years.
Without treatment, gonorrhoea can lead to serious long-term health problems, including infertility and potentially life-threatening pelvic inflammatory disease in women. In pregnant women it can also cause permanent blindness in a newborn.
Almost 35,000 cases of gonorrhoea were reported in England last year and it is the second most common bacterial sexually transmitted infection (STI) in the UK after chlamydia. The majority of cases affect people under the age of 25.
Infected patients may experience discharge or pain while urinating, but about 10% of men and almost half of women do not suffer any symptoms.
Research published this year suggested that some GPs are prescribing antibiotics that no longer work for people with gonorrhoea, raising the chances that drug-resistant forms will spread.
The study led by PHE, published in the journal BMJ Open, found that many GPs were still giving their patients ciprofloxacin, even though it has not been recommended for treatment since 2005.
In 2007 ciprofloxacin was on 42% of prescriptions for gonorrhoea, and even as recently as 2011 it was still prescribed in one in five cases.
Dr Andrew Lee, PHE’s consultant in communicable disease control, said: “Investigations are ongoing into a number of cases of antimicrobial resistant gonorrhoea, these are seen from time to time around the country and those affected have been effectively treated with alternative antibiotics. We know that the bacterium that cause gonorrhoea can mutate and develop new resistance, so we cannot afford to be complacent.
“Individuals can significantly reduce their risk of any STI by using condoms with all new and casual partners and getting tested regularly. Public Health England will continue to monitor, and act on, the spread of antimicrobial resistance and potential gonorrhoea treatment failures, to make sure they are identified and managed promptly.”
