Gonorrhoea, and antibiotic resistance

Gonorrhoea has been with us a very long time. The Greek physician Galen named it in the second century, from words meaning flow of seed, having decided the discharge was leaking semen. He was wrong about the fluid but the name stuck for nearly two thousand years, which tells you something about how long we have been failing to get rid of this one. The old nickname, the clap, is older than any reliable explanation for it.

Why it is taken seriously now

For most of the twentieth century gonorrhoea was an inconvenience you cured with penicillin. That era is ending. The bacterium has shrugged off one antibiotic after another, and it is now treated with a single injection that is close to the last reliable option we have. The World Health Organisation has warned openly about untreatable gonorrhoea, and cases of so-called super-gonorrhoea, resistant to the front-line treatment, keep appearing. This is why gonorrhoea, unlike some infections, gets a test of cure: a repeat test after treatment to prove the drug actually worked. We are, in effect, checking whether we still have the upper hand.

The stakes if it is missed are not only about resistance. Like chlamydia it can cause pelvic inflammatory disease, and gonorrhoea tends to cause the more aggressive, acutely painful version: severe pelvic pain, fever, an illness that can land someone in hospital, and the same permanent scarring that leads to chronic pelvic pain, infertility and ectopic pregnancy. In men it causes epididymitis, the hot, grossly swollen, agonising testicle that people remember for the rest of their lives, and it can leave lasting scrotal pain behind it. Occasionally gonorrhoea escapes into the bloodstream and causes disseminated gonococcal infection, with fever, hot swollen joints you can barely move, and a scatter of skin lesions. And a baby born to an infected mother can develop a severe eye infection that once blinded newborns in large numbers. That single fact is why, for over a century, newborns had drops put in their eyes as a matter of routine. Gonorrhoea shaped delivery-room practice worldwide.

How it is found and treated

A NAAT test on urine or a swab detects it, with throat and rectal swabs added where relevant, since those sites are usually silent and are exactly where resistant strains are thought to brew. Treatment is an antibiotic injection, followed by a test of cure. Partners need testing and treatment too.

The honest summary

Gonorrhoea is common, often silent, and no longer the pushover it was. Treating it correctly the first time, at every site, and checking it has cleared, is how we keep the last antibiotic working. Take it seriously; the bacterium certainly is.