In public health news...

Yes, it's time to re-visit that old favourite topic - sexually transmitted diseases (and how people manage not to take risks seriously.)

It's from Catalyst tonight, and it started with a bit of history that reinforced my puzzlement about how syphilis for centuries did not manage to stop people sleeping around: 

 Professor Basil Donovan
Syphilis used to kill more people every year - year in, year out - than HIV did in its worst ever year. And it did that for 400 years. Back in 1908, one in eight babies were said to be dying of syphilis in Melbourne.

It seems to me that such a devastating and relatively common disease ought to have featured more in the novels of the pre-antibiotic era; yet from my limited knowledge of the "classics", it's not that often a plot point.   I mean, how come when AIDs was at its height it was the subject of umpteen plays, movies, books, etc, yet people seemed to shrug off the mayhem syphilis was causing ever since it turned up in Europe?   Anyway, that's another post, perhaps...

Back at Catalyst, the whole point of the story was that it seems medical scientists are virtually at panic stations about the likely spread of antibiotic resistant gonorrhoea:

Professor Matt Cooper
For gonorrhoea, we've now got to the stage where we have one particular strain, H041, where we've only got one antibiotic that kind of works, and even that's not effective.

NARRATION
It's this - Ceftriaxone.

Dr Graham Phillips
So, what happens when that doesn't work anymore?

Professor Matt Cooper
You're screwed, pardon the pun. So we have no therapy left. And in 2011, in a sex worker from Japan, they isolated a Ceftriaxone-resistant gonorrhoea. So no antibiotics worked....

NARRATION
And the rogue Japanese strain is now here, as well as other cities around the world.

Professor Basil Donovan
You know, there's every possibility that within a couple of years that that strain of the organism could take over.

NARRATION
Untreatable gonorrhoea is not a nice prospect. It can cause infertility in women, and blindness, even in babies born to infected mothers. It can also spread through the body to the heart and bones. The bacteria are particularly clever at getting around our defences.

One of the links from the Catalyst web site is to a paper from 2012 co-authored by some of the Professors who appeared on the show. Here's the abstract, which pulls no punches:

From a once easily treatable infection, gonorrhoea has evolved into a challenging disease, which in future may become untreatable in certain circumstances. International spread of extensively drug-resistant gonococci would have severe public health implications. It seems clear that under the current treatment pressure from extended-spectrum cephalosporins, and owing to Neisseria gonorrhoeae's remarkable evolutionary adaptability, further rise of ceftriaxone-resistant strains around the world is inevitable. Simply increasing the doses of extended-spectrum cephalosporins will likely prove ineffective in the long run, and has been a lesson learnt for all single-agent therapies used for gonorrhoea to date. We recommend that dual therapy, especially those consisting of extended-spectrum cephalosporins and azithromycin, be adopted more widely and complemented by strengthening of antimicrobial resistance surveillance. Unless there is urgent action at international and local levels to combat the problem of N. gonorrhoeae antimicrobial resistance, we are in for gloomy times ahead in terms of gonorrhoea disease and control.

In the conclusion it is noted:

It is probably only a matter of time before extensively drug-resistant N. gonorrhoeae strains become widespread and treatment failures, particularly for pharyngeal gonorrhoea, become commonplace.  

Pharyngeal gonorrhoea?  Hard to say what would be more depressing, having an untreatable genital problem, or a throat infection that just would not go away.

Anyway, the end point is this:

Action is therefore urgently needed at local and international levels to combat the problem. We advise that government agencies take this threat seriously and provide urgently needed funds for increased research, surveillance activities and vaccine development.

Well, yes.  A vaccine would be a good idea for an untreatable form of infection, no? 

I see that it has been the subject of some research going back to at least the 1970's, but as the article at that last link shows, other diseases have been the subject of much greater effort in vaccine research.

It seems it's time for that to change....