The bacterium that causes the common sexually transmitted infection (STI) gonorrhoea develops resistance to antibiotics easily, and some cases of multidrug-resistant gonorrhoea, originating from abroad, were reported from the UK this year, raising concerns that gonorrhoea could become untreatable.
However, a recent paper finds that gonorrhoea drug resistance is largely under control in the UK apart from these isolated cases, does not seem to be getting worse, and may be even improving in gay men.
These are the relatively reassuring findings of the study published in F1000Research that set out to test the opposite hypothesis. The authors aimed to show that resistance of gonorrhoea to antibiotics has increased due to more gay men getting tested – which has resulted in more taking antibiotic treatment.
The researchers compared antibiotic resistance in gonorrhoea treated in gay men and in women in the UK and in Belgium.
There are very different rates of rectal gonorrhoea testing in the two countries in gay men – in the UK, 70% of gay men who were recently screened for an STI reported they had an anal swab for gonorrhoea, compared with just 9% in Belgium.
The authors’ hypothesis was that levels of treatment are directly related to levels of resistance – the more antibiotics are used, the more likely they are to create resistance. If levels of antibiotic treatment for gonorrhoea are related to resistance, then because far more gay men than women are tested for and diagnosed with gonorrhoea in the UK, gonorrhoea would be more resistant to the current drugs used to treat it in gay men than in women. But in Belgium, where testing and treatment rates are not higher in gay men, there would not be more drug-resistant gonorrhoea in gay men than women.
If the evidence supported this, it would pose a dilemma – should UK sexual health clinics continue to screen and treat high numbers of gay men for gonorrhoea if all it is doing is hastening the development of drug resistance in this notoriously adaptable bacterium?
Luckily the evidence appears to offer little support for this hypothesis at this point in time.