With sensationalism dominating mass media narratives, it is often difficult to assess how much of a threat are all those ‘outbreaks’ and ‘epidemics’ that are often being mentioned in the news. It is not unheard that media might overestimate (or underestimate) the potential impact and severity of certain problems, so some scepticism in this regard is certainly not unjustified.

However, how did the media do when it comes to a new strain of antibiotic-resistant gonorrhoea for which the sensation-loving journalists quickly accepted the name ‘super-gonorrhoea’? With just 34 reported cases in 2014, when the hype about super-gonorrhoea was at its peak, many argued that outbreak of this scale is not really worthy of national news, let alone the title of ‘epidemic’ that many journalists pined on it.

However, what actually captivates the public’s attention here is a much deeper and more serious. It has to do with the bacterial infections in general, and the fact that our over-reliance on antibiotic has contributed to an increase in antibiotic resistance in bacteria in general. If this trend is to continue, the scientists hypothesize that the impact on global healthcare system will be major.

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Super gonorrhoea and antibiotic resistance

The problem of ever-growing resistance to antibiotics among various strains of bacteria is often underestimated, despite the fact that this is a global and very serious problem. Some experts have gone as far as to compare antibiotic resistance to climate change due to its far-reaching consequences in the near future.

With the media reports about drug-resistant super gonorrhoea going wild, we decided to present to our readers an article that will take an objective look at the issue, exploring the subject of super gonorrhoea in more detail.

Who is at risk of super gonorrhoea?

When it comes to STI trends, statistics and expected patterns, involving data on high-risk groups for example, there is no significant difference between typical gonorrhoea and super gonorrhoea – both are caused by bacteria belonging to the same family of microbes and both conditions are spread the same way, causing the same symptoms and the same complications. The only difference, of course, is that typical gonorrhoea can be treated with antibiotics relatively easily, while super gonorrhoea might require much more complex treatment.

Gonorrhoea is the third most commonly diagnosed sexually transmitted infection in the United Kingdom, with a significant portion of those affected being homosexual men (up to 68% of all diagnosed cases). Among heterosexual people, around 55% of cases were discovered in the age group 15-24. In addition to this, the rates of gonorrhoea seem to be highest in the urban areas, with London housing absolute majority of diagnosed cases.

Despite this, gonorrhoea can affect anyone who is sexually active, especially if precautions related to safe sex practices are not taken. Super gonorrhoea follows these patterns, but is not exclusive to either one of the mentioned high-risk groups. It has been observed both in homosexual men and in heterosexuals, and while it might be somewhat more common among younger people, the rates of gonorrhoea among those aged 45 or more are actually on the rise. Again, everyone who is sexually active is at risk.

Super gonorrhoea symptoms

Another thing that gonorrhoea is known for is its ability to be present within the organism and still be contagious without manifesting any noticeable symptoms. And even when they do manifest, there is rarely any consistent and uniform pattern of their development among those affected.

This means that different individuals may notice different signs and symptoms of gonorrhoea in different order, at different times. For some, the early symptoms may appear as early as 14 days after the infection took place, while other might fail to notice any changes whatsoever until a couple of months have passed or the infection has spread to other parts of the body.

As is the case with many other STIs, symptoms can also depend on the sex of the person infected. So, for example, symptoms in women might include changes in vaginal discharge (it can become thin or watery, yellowish to green in colour), pain and discomfort in the lower abdomen, bleeding between menstrual periods or more intensive periods. On the other hand, men can notice the presence of penile discharge (white, yellow or green) with tenderness in the testicles. In addition to these sex-specific symptoms, both men and women affected will notice painful urination as a very common symptom of super gonorrhoea.

In addition, gonorrhoea can also affect other bodily parts, most notably the rectum or throat, in case it has been transmitted through unprotected oral or anal sex. If the sperm or vaginal fluid of the affected individual comes into contact with the partner’s eyes, then conjunctivitis might develop.

However, despite this, one in ten affected men and around 50% of affected women will experience absolutely no symptoms.

Super gonorrhoea complications and long-term consequences

Just like with the regular gonorrhoea, super gonorrhoea can cause significant complications and more serious health issues if left untreated, or if it is not responding to treatment the intended way. In women, gonorrhoea can spread to other reproductive organs, thus causing issues such as pelvic inflammatory disease (PID), blocked or permanently damaged fallopian tubes, infertility or ectopic pregnancy. On the other hand, in men it can lead to painful infection of the testicles and reduced fertility. Less commonly, gonorrhoea can also cause inflammation of the joints and skin lesions.

However, despite these grim possibilities, gonorrhoea is unlikely to cause any long-term problems if it is properly and timely treated. However, if the effective treatment is absent, as can be the case with super gonorrhoea, the infection may spread to other parts of the body. The more it spreads, the greater are the chances of further complications.

What is super gonorrhoea?

The term used to denote this new strain of gonorrhoea-causing bacteria is not really liked by scientists and medical experts, mostly because it has more to do with sensationalism that with precise naming conventions. The usage of the term ‘super’ seems to indicate that this new strain is more contagious, more dangerous or more aggressive as opposed to typical gonorrhoea. However, neither of this is true.

The term ‘super’ actually denotes the ‘superbug’ capacity, or in more professional terms, antibiotic resistance. This means that due to artificial mechanism of selection brought on by our use of antibiotics, gonorrhoea has in a way ‘evolved’, developing the ability to withstand the most commonly used antibiotic treatments. At this point, the strain of bacteria that is commonly known as super gonorrhoea is resistant to one of the two major treatments, Azithromycin. This means that, at least for now, it can still be successfully treated with another antibiotic, Ceftriaxone. However, if super gonorrhoea develops resistance to this medicine too, it can become effectively untreatable.

Why has antibiotic resistance developed in gonorrhoea?

Although super gonorrhoea got a lot of media attention, it’s neither the only nor the first bacteria that developed a resistance to antibiotic treatments. Our use of antibiotics presents an artificially introduced factor of selection for microorganisms and the ability of bacteria to withstand treatment is often the difference between reproducing and dying out. And the same is true for more than 80 years at this point. Infections that were thought to be potentially fatal before 1930s are today viewed as trivial. But at the same time, unwillingly, we have been forcing bacteria to adapt and evolve in order to survive, and the biggest advantage they can get in the modern world is resistance to antibiotics.