Last year there were several reports in the media of a highly resistant strain of gonorrhoea, mostly in the north of England and mostly in heterosexuals. The particular strain is resistant to Azithromycin, which is used as a dual therapy together with ceftriaxone intramuscular injection. There is now evidence that this highly resistant strain is spreading to the rest of the UK including London and is now also spreading in men who have sex with men.

The issue of antibiotic resistance has been making headlines for some time. As most of us know we are entering a period where we are starting to run out of options when it comes to treating certain bacterial infections, a by product of years of sometimes inappropriate antibiotic prescribing.

There are very few antibiotic options left when it comes to treating gonorrhoea. A few years ago we commonly treated gonorrhoea with 2 doses of two different oral antibiotics. The treatment guidelines were changed to dual therapy with an injectable antibiotic, ceftriaxone together with oral azithromycin, as the it reduced the likelihood of the bacteria becoming resistant to two different antibiotics simultaneously, even though gonorrhoea is known to be able to develop resistance quickly.

The problem with azithromycin resistance to gonorrhoea is that there would then be no secondary mechanism in place to keep the bacteria from also becoming resistant to ceftriaxone, the current first line treatment. This is a real problem as it would mean that gonorrhoea would essentially become untreatable.

It is vital that we all understand the importance of this. Some website especially ones who provide online testing and treatment, are still issuing outdated oral treatment only. If you have been diagnosed with gonorrhoea you will need an injection and follow up. It is also essential that samples are tested for azithromycin resistance and that partners of potential contacts are contacted and treated. It is now also advised that a test of cure is performed. This requires retesting of anyone who was found to have been infected with gonorrhoea to ensure that the treatment was successful and that the affected people do not keep spreading the resistant strain.