Gonorrhoea isn’t a new condition. It’s been around for several centuries, with the earliest case thought to have been in 1611. But while it is an infection we know, new strains have developed in recent decades due to antibiotic resistance; in some cases making it a difficult infection to treat.

With Sexual Health Week just around the corner, we’ve delved into the history of gonorrhoea through the ages, from the first suspected case through to the present day.

Gonorrhoea: what type of infection is it?

Gonorrhoea is a sexually transmitted bacterial infection, which used to be known as ‘the clap.’ It is caused by a type of bacteria known as Neisseria gonorrhoeae. The bacteria is found mainly in the discharge in either penile or vaginal fluid/discharge. 

This means it can be passed on through sexual intercourse - and can be transmitted anally, orally or vaginally. It can also be passed on through sharing sex toys where the bacteria is still present. 

Symptoms will not always be noticeable, but can sometimes include unusual discharge from the vagina or penis, pain or burning in these areas also, inflammation of the foreskin and pain or tenderness in these areas. 

Gonorrhoea is normally quite straightforward to treat, with a single intravenous antibiotic injection in conjunction with an oral antibiotic tablet. However successful eradication of the infection does not mean you are immune to catching it again, so safe sex is always recommended. 

How is super gonorrhoea different?

Super gonorrhoea is the same as gonorrhoea in every sense excluding treatment. Where gonorrhoea can usually be eradicated easily with antibiotics, super gonorrhoea occurs where the bacteria have grown highly resistant to antibiotics and other forms of treatment. Meaning there is no known cure. 

While there have only been three reported cases of super gonorrhoea in the UK, it is still a great public health concern. The issue of antibiotic resistance is not exclusively related to gonorrhoea either, and has been identified in a number of infections including pneumonia, tuberculosis and salmonellosis. 

When and where did gonorrhoea start?

Gonorrhoea has been around for several centuries. The earliest recognition of the infection (presenting symptoms consistent with gonorrhoea) is thought to have been in 1611. The English Parliament enacted a law with the aim of managing the spread of the infection. 

Treatments at this time usually took the form of herbal composition, and it’s questionable how effective these would have been. 

Later on in the 19th century, common treatments for gonorrhoea focused mainly on the reduction of common symptoms such as burning, inflammation and discharge. Eradication of the bacteria itself wasn’t the priority. 

Isolation of the bacteria

That was until 1879, when a man named Albert Ludwig Sigesmund Neisser discovered and observed gonorrhoea bacteria for the first time. He called the bacterium Neisseria gonorrhoeae. This discovery prompted new treatment types of antiseptic nature, such as silver nitrate. These treatments were applied directly to the area of infection - usually the urethra or cervix. However, these treatments still focused primarily on symptoms. Complete eradication was still not possible at this time. 

The discovery of penicillin

In 1928, penicillin was discovered, which was the first antibiotic. It was a revolutionary development in medicine. This paved way to a period between 1940-60, nicknamed the ‘golden age’ of antibiotic discovery. Gonorrhoea, among a broad canvas of other infections, was not effectively curable. As antibiotics treatments became more developed and refined, less side effects occurred.

However, this is not the end of the ‘story’ of gonorrhoea. Antibiotics were not the means to an end, but a present solution to a present problem. The very nature of bacteria is that it is ever in a state of change and evolution. Certain strains of the gonorrhoea bacteria grew resistant to antibiotic treatment. The problem was made far worse by a ‘discovery void’ of new antibiotics towards the end of the 20th century. 

Why are antibiotics becoming less effective in gonorrhoea and others? 

Essentially because they’ve been overused. There are other reasons, however, including patients not finishing their entire course of antibiotics, poor infection control in healthcare environments, poor hygiene and an absence of new antibiotics. 

It’s a problem that was foreseen by the scientist who discovered antibiotics, Alexander Fleming. Penicillin was introduced in 1943, but resistance was identified even earlier than this at around 1940. So before penicillin was even available to the public, we already knew that there was a potential for resistance. 

Historically, penicillin was the first antibiotic to be used. It was deemed that its potential for good far outweighed any negative concern of bacterial resistance. 

So much so, that in 1945, Fleming was awarded the prestigious Nobel Peace Prize. He used the opportunity in his speech to warn of these concerns. He gave a hypothetical scenario in which: 

“Mr X has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife.

Mrs X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs X dies. Who is primarily responsible for Mrs X’s death? Why Mr X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.”

Fleming predicted and identified part of the problem here, which is why there is usually an emphasis on finishing a course of antibiotics when they are prescribed.

To give an example, antibiotics in relation to a sore throat. If a child has a sore throat, the concerned parent will usually take their child to see a doctor. A sore throat could be a symptom of a bacterial infection, but in most cases will be the result of a virus - which antibiotics cannot treat. 

A few years ago, and still today in some areas, people used to expect a doctor to prescribe antibiotics for sore throats, coughs and colds - and many doctors, in order to avoid confrontation, might have prescribed them. Because most sore throats, coughs and colds improve within a few days without antibiotics, it’s easy to see why people thought the antibiotics had cured them and reinforced the belief that antibiotics are helpful. We now know that not only are they generally ineffective for minor illnesses, they may actually be causing harm. This overuse of antibiotics for both humans and animals has allowed the bacteria to become familiar with, and resistant to, antibiotic treatment. 

We can all make a difference by consulting with our doctors and agreeing jointly when it is most appropriate to take antibiotics and when just to allow our body’s natural immune defences to to do their job.

Is there a chance I could catch super gonorrhoea? 

While the chances are slim, they still exist. Only three people in the UK have been known to have had super gonorrhoea, and all were successfully treated after numerous laboratory tests and treatment attempts. The number of people living in the UK with super gonorrhoea which they may not even know about, could be much higher. 

One of the three people contracted the highly resistant infection outside the UK - one woman contracted it inside the UK. We have no way of knowing but she might have encountered the same problems of an inadequately treated partner that Fleming’s ‘Mrs X’ suffered.  

Because gonorrhoea and certain other sexually transmitted infections are easily treatable, this may make practicing safe sex slightly less of a priority to certain people. You can read more about practicing safe sex here

The importance of safe sex cannot be understated, and it should be of increased significance to everybody in relation to antibiotic resistance. If this problem escalates, there is the danger that a ‘quick fix’ in relation to sexually transmitted diseases like gonorrhoea, may one day be a thing of the past.