April 14, 2021

The United Kingdom investigates an outbreak of multidrug-resistant gonorrhea | Society

The United Kingdom investigates an outbreak of multidrug-resistant gonorrhea | Society

The United Kingdom investigates since December an outbreak with at least four cases of a variant of gonorrhea resistant to almost all antibiotics. The authorities of that country place the origin in Ibiza, since the infected ones – all British – traveled during the past summer to the island or they maintained sexual relations with people whose infection was linked with her, According to a study that appears in the journal of public health Eurosurveillance.

The disease-sexually transmitted-affects the genitals, mouth and rectum, which can hurt or ooze. It is estimated to be contracted by more than 106 million people per year, according to WHO. In Spain, more than 5,000 cases were registered last year.

The strain involved is FC428, which arose in China or Southeast Asia and which until now had only caused sporadic cases outside that continent. This outbreak is the first record of "sustained local transmission" in Europe of the strain, according to the Public Health Agency of England (PHE, for its acronym in English). The Ministry of Health of the Balearic Islands ensures that it has not registered any diagnosis of FC428.


Sources: Public Health England (PHE), Eurosurveillance and own elaboration based on scientific publications.

The first case was detected in October at a sexual health clinic in the United Kingdom. The patient, who suffered discomfort in the urinary system, explained that in August she had spent a few days on vacation in Ibiza, during which she had unprotected sex with more than one compatriot.

The woman was cured after receiving a dose of 500 milligrams of ceftriaxone intramuscularly and another oral one gram of azithromycin, so her case did not initially attract attention. It was later cultures that revealed that the gonococcal bacteria was immune to the first antibiotic and had intermediate resistance to the second.

A month later, a second woman came for a check-up at another clinic in the United Kingdom. Although he did not present any symptoms, he explained that he had maintained unprotected relationships with a man who had spent the summer in Ibiza. The analyzes showed that the woman was a carrier of the bacteria. Subsequent tests showed that the pathogen that had infected both women was the same.

The link was the sexual partner of the second case, who also had "had relations with the network of contacts in the first case," according to the PHE study. Interestingly, this man was negative in the analyzes. The researchers consider that "it is most probable that he is the source of infection in the second case and that he has eliminated the infection spontaneously".

The bacteria was much harder to eliminate this time. The woman first received a dose of one gram of ceftriaxone. Despite this, days later he began to suffer discomfort in the rectal area, which did not subside after the administration of two other antibiotics (azithromycin and gentamicin). Finally, three doses of another antibiotic (ertapenem) were needed intravenously on successive days for the bacteria to disappear.

The infected fourth of the outbreak is another man, with whom the woman in the second case maintained relationships when she was still asymptomatic. He was also treated with three doses of ertapenem intravenously.

A microbe emerged in the Far East

A young man in his early 20s was the first known patient of the gonococcus FC428 strain, a superbug which has developed resistance to antibiotics such as ceftriaxone, efixima, penicillin, tetracycline and ciprofloxacin, and which has also done so in an intermediate way with azithromycin. The diagnosis was made in Tokyo in 2015 and since then FC428 has only been isolated in half a dozen more patients in Canada, Australia, Ireland, France and Denmark.

In almost all cases, the investigations made referred to China and Southeast Asia as the focus of contagion, often in environments linked to prostitution to which the viakeros went. According to the study, this area was the place where the strain was expected to emerge and has been "the reservoir" from which the strain has been sporadically jumping to the rest of the world.

Once confirmed its transmission in Europe, "authorities and professionals of public health and sexual health should be aware of the potential of the FC428 to expand" across the continent, "putting at risk the effectiveness of current treatments against gonorrhea", concludes the study of the United Kingdom.

The European Center for Disease Control and Prevention (ECDC), in its acronym in English) has promoted a specific working group that monitors "the sensitivity of the bacterium Neisseria gonorrhhoeae to the antibiotics used for their treatment, "explains Gianfranco Spiteri, the latest results (corresponding to 2017) have shown no remarkable changes in resistance to antibiotics such as cefixime, ceftriaxone and azithromycin compared to recent years. Today we are deeply concerned because they compromise the affectivity of the dual treatment of first line against gonorrhea with ceftriaxone and azithromycin, "adds Spiteri.

For the ECDc, it is particularly worrisome that "several of the last known cases have required intravenous treatment" with an antibiotic such as ertapenem, which for José Miguel Cisneros, president of the Spanish Society of Infectious Diseases and Clinical Microbiology, has the status of "strategic and it should be used as little as possible. "

When the British authorities concluded that all cases were related, the European warning mechanisms were put in place. "The British alerted the European Center for Disease Control and Prevention and he contacted us in January as a potentially affected country," recalls Julio Núñez, director of the National Center for Microbiology. The next step was to inform the Government of the Balearic Islands, although none of the strains isolated in recent months in the Can Misses Hospital in Ibiza or in the public surveillance network have shown resistance to antibiotics or have any relation to the cases of the Kingdom. United, adds Núñez.

"This case is very illustrative to understand the global nature of the problem we are facing," says Adrià Curran, of the infectious diseases unit at the Vall d'Hebron Hospital in Barcelona. "It is a strain that emerged in Asia, which has reached a tourist destination like Ibiza and has jumped to the United Kingdom, where it has been diagnosed in heterosexual women. We have been warning for years about the increase in the incidence of sexually transmitted diseases. This shows that it is not a phenomenon reduced to some countries, groups or concrete practices, "he summarizes.

For José Miguel Cisneros, president of the Spanish Society of Infectious Diseases and Clinical Microbiology, cases like this show the "need to implement molecular diagnostic tools in a systematic way". "The resistances are reversible. If we stop exposing the bacteria to many antibiotics, they will be sensitive to them again. This is the good news at the end of the road. To achieve this, it is necessary to know better what we are facing to fight it with the tightest antibiotic: the genomic sequence is the path, "he concludes.


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