Emergence of untreatable gonorrhoea in England and Wales

Besi Besemar February 26, 2013

Health Protection Agency

The first Gonorrhoea Resistance Action Plan for England and Wales has been published, and recommends a heightened national response to combating the serious threat posed by the emergence of untreatable gonorrhoea.

The Action Plan was developed by the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP), established by the Health Protection Agency (HPA) to monitor the growing global problem of emerging resistance over the last decade in the absence of new therapeutic options.

Gonorrhoea is the second most common bacterial sexually transmitted infection (STI) in England. In 2011, new diagnoses rose to nearly 21,000, jumping 25 per cent in one year. Over a third of cases were in men who have sex with men, up from around a quarter in 2010. GRASP 2011 data suggest that up to third of reported cases were repeat gonorrhoea infections.

Professor Cathy Ison, lead author of the GRASP Action Plan, HPA, said:

“Ensuring treatment resistant gonorrhoea strains do not persist and spread remains a major public health concern. The GRASP Action Plan raises awareness of this important issue and sets out practical, measurable actions to extend the useful life of the current recommended therapies in England and Wales.”

In England and Wales, the risk of gonorrhoea resistance developing in current first-line therapies (ceftriaxone and azithromycin) fell slightly for the first time in five years in 2011. However, cases of treatment failure have now been reported globally and, with no new antimicrobial agents in the pipeline, England’s Chief Medical Officer recently advised government to add the threat of infection resistance to frontline antibiotics to the civil emergencies risk register.

Professor Dame Sally Davies, Chief Medical Officer, said:

“We have seen a worrying rise in cases of drug resistant gonorrhoea over the last decade. Antimicrobial resistance to common drugs will increasingly threaten our ability to tackle infections and the Health Protection Agency’s work is vital to addressing this threat. As Chief Medical Officer, and with the Department of Health, I am supporting the work of the HPA with my forthcoming annual report Volume Two, which focuses on infections and antimicrobial resistance, and the Department’s new UK five year Antimicrobial Resistance Strategy and Action Plan.”

The GRASP Action Plan supports the public health control of gonorrhoea, and gonorrhoea resistance, by providing guidance on robust and timely data collection, rapid detection of treatment failures, adherence to management guidelines, and actions to reduce gonorrhoea transmission.

Dr Gwenda Hughes, head of STI surveillance at the HPA, said:

“We are seriously concerned about continuing high levels of gonorrhoea transmission and repeat infection, suggesting we need to do more to reduce unsafe sexual behaviour. The GRASP Action Plan advocates comprehensive health promotion programmes to encourage safer sexual behaviour, particularly in higher risk groups such as men who have sex with men, alongside maintaining good access to STI screening and sexual health services.”

Paul Ward, Deputy Chief Executive of Terrence Higgins Trust, said:

“The emergence of drug-resistant gonorrhoea poses a very real threat to the gay community, which already has a worryingly high level of infection. It is vital that men are aware of the risks and armed with the knowledge to protect themselves and their partners. Condoms are the best protection against gonorrhoea. However, men can carry the infection without being aware and even those who believe they have been safe might have been at risk, particularly through oral sex. Having gonorrhoea also makes it far easier to pick up or pass on HIV. This is why we recommend gay and bisexual men go for a sexual health check up at least once every six months if they are having sex with new or casual partners.”