There is more and more gonorrhea in the world. It is growing at a dizzying pace: its impact has multiplied by 10 in a scant couple of decades. In addition, traditional treatments are losing efficacy and the disease does not have a specific vaccine, a combination of factors that worries the medical community because it may end up rendering the medicine used today against this Sexually Transmitted Disease (STD) useless, although this problem , at the moment, is localized in certain parts of the world. There is more bad news: if left untreated, gonorrhea can cause serious health problems, from infertility in women in the medium term to increasing the risk of contracting AIDS.
Young people forget about condoms when they lose their fear of getting infected, which causes an increase in sexual diseases
But there is also good news: three studies just published in the journal The Lancet Infectious Diseases show that the meningitis vaccine also offers good results against gonorrhea, especially among young people – the most affected people – and homosexual men, the magazine clarifies. In 2020, more than 80 million cases of this disease were diagnosed in the world. In Spain, the incidence has multiplied by 15 in a couple of decades, going from 805 cases per 100,000 inhabitants in 2001 to 12,359 in 2019 (latest data available).
“The drop in the effectiveness of treatments against the responsible bacteria –Neisseria gonorrhoeae– and the lack of a vaccine to prevent infection have raised concerns that gonorrhea may become more resistant to treatment, or even untreatable in the future.
Matilde Sánchez Conde, infectologist and head of the STD department at the Ramón y Cajal Hospital in Madrid and spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology, puts the impact of gonorrhea in the world in context: “In Spain it grows by 20% annual. In the US Centers for Disease Control and Prevention (CDC) they include it among the five major health problems that must be solved. It is a global health problem that affects quite young people and that is worrying”, she describes, in addition to its own consequences, “because having an STD favors acquiring others. The risk of contracting HIV is multiplied by three if you have another sexually transmitted disease”, she illustrates.
The expert also clarifies that the situation is not the same in Spain as in other parts of the world. “In our environment there has been little development of resistance to antibiotic treatment, which normally works. They have been described in some places in Asia, such as Japan, or the USA. In Europe there was a mini-outbreak of a traveler coming from Japan who infected two women with a gonococcus that was resistant to basically everything. But in general in Spain and Europe it is not happening, ”she explains. In places like these, the risk may be underdetection, she adds, because sometimes the disease is confused with other ailments or is asymptomatic.
The Lancet reports that based on the recommendation of the World Health Organization (WHO) that vaccines against meningitis be used to reduce the impact of this disease, including their use in children as part of national vaccination strategies, most The availability of this preparation has made it possible to verify that it also offers protection against gonorrhea. “Even partial protection could reduce infections considerably,” he explains. The Lancet in a press release.
“In 2016, the WHO set a goal of reducing the incidence of gonorrhea by 90% by 2030, but there is still no effective vaccine,” the magazine recalls. “Three studies suggest that the 4CMenB vaccine [para la meningitis B] may offer significant protection for young adults and men who have sex with men, who may be at higher risk of infection.
Between 33% and 40% protection
The first of the studies was conducted in New York State., including the city, and in Philadelphia. The group led by Dr. Winston Abara, from the CDC, evaluated more than 110,000 young people with laboratory-confirmed infections of gonorrhea, chlamydia (another STD) or both, of whom 7,692 were vaccinated, approximately half with one dose and the other half with two Among these, the doctor observed, a full course of the meningitis vaccine (two doses) offered 40% protection and a single injection 26%.
“Our findings suggest that meningitis vaccines that are only moderately effective in protecting against gonorrhea may have a large impact on the prevention and control of the disease,” explains Winston Abara. “Clinical trials on the use of 4CMenB against gonorrhea are needed to better understand its protective effects, and also provide insights to move towards the development of a gonorrhea-specific vaccine.”
A similar conclusion was reached by the team of Professor Helen Marshallof the Women’s and Children’s Hospital in Adelaide, Australia, the country, says The Lancet, with the largest 4CMenB vaccination program in the world, including children, adolescents and young adults. In this case, the protection was set at 33% against gonorrhea, although the author herself admits that her study has some limitations. For example, a small number of subjects.
A slightly different approach was taken in the UK, where they wondered what effective economic savings and what impact on health the use of the vaccine could have to reduce the incidence of gonorrhea. Professor Peter White of Imperial College developed a model to compare three possible ways of vaccinating a group specifically prone to gonorrhea: men who have sex with men. The question was whether it is better to vaccinate those who go to sexual health clinics, those with confirmed gonorrhea or those with a higher risk of infection.
According to the analysis carried out, the authors of the study concluded that the most effective is to vaccinate the risk profiles with 4CMenB, and that this measure could save the British system 110,000 cases and eight million pounds -9.6 million euros – in ten years. “With a gonorrhea-specific vaccine that will take years to develop, the key question is whether the 4CMenB meningitis vaccine should be used against gonorrhea. Our analysis suggests that giving it to those who are most at risk of infection is the most effective way to avoid large numbers of infections, “concludes White.