We need to talk about super gonorrhoea

We need to talk about gonorrhoea. This sneaky STI used to be known as “the clap”, which makes it sound positively archaic, but it's actually more prevalent than ever. In June, a report by the UK Health Security Agency (UKHSA) revealed that 85,223 people were diagnosed with gonorrhoea in England in 2023, the highest number since records began in 1918.

That's an alarming rise of 7.5% year-on-year – by comparison, there were 79,268 gonorrhoea cases in England in 2022 – and three groups are bearing the brunt: MSM (men who have sex with men), the Black Caribbean community, and young people aged 15 to 24.

Dr. Benjamin Weil of health nonprofit The Love Tank tells Huck that “declining condom use” since the NHS introduced HIV prevention pill PrEP in 2017 is “a widely cited reason” for the increase. “But it's not the whole story,” Dr. Weil says. “We've seen repeatedly that funding cuts to sexual health clinics across the country is a big driver of upticks in infections.”

Like chlamydia, the only STI that's even more rampant in the UK, gonorrhoea spreads easily through condomless anal, oral and vaginal sex. One in 10 people with a penis who catch gonorrhoea – and one in two with a vagina – won't experience any obvious symptoms, which makes it easy to pass on unknowingly. But if you do exhibit symptoms, they probably won't be pleasant.

Joey Knock, a 34-year-old cis gay man from London, tells Huck that he has had gonorrhoea “in the butt” on numerous occasions. “It's given me diarrhoea and made me poop out mucus, which left me feeling really wiped out. I was reaching for all the electrolytes I could get afterwards,” he says. Other common symptoms include a thick green or yellow discharge from the vagina or penis and pain when peeing. People who menstruate can also experience bleeding between periods.

Thankfully, once Joey sought medical treatment and began taking antibiotics, he would always start to feel better “within hours”. But if it's left untreated, gonorrhoea can cause infertility in people of all genders. Basically, if you think you've got it, you need to get tested as soon as possible.

If you're diagnosed with gonorrhoea, you'll be prescribed antibiotics – no big deal, right? Not quite. In August, the UKHSA warned of a “concerning rise in antibiotic-resistant gonorrhoea infections”. Between June 2022 and May 2024, 15 “super gonorrhoea” cases in England were found to be resistant to ceftriaxone, the “first line” antibiotic given to gonorrhoea patients.

Of these 15 cases, five were found to be “extensively drug-resistant”, which meant they were “resistant to both first and second-line treatment options and to other antibiotics”.

Numbers are currently small, but there's potential for this acorn of resistance to grow into an oak of unshiftable gonorrhoea. Dr Helen Fifer, a consultant microbiologist at  UKHSA, put it plainly in the August report: “Gonorrhoea is becoming increasingly resistant to antibiotics, risking the possibility of it becoming untreatable in the future.”

But perhaps the most frustrating thing is that experts have already found a way to halt gonorrhoea's ongoing rise. In November 2023, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that the MenB vaccine should be offered to people “at the greatest risk” of contracting the STI including MSM with multiple sexual partners.

The MenB vaccine – marketed as Bexsero and sometimes called 4CMenB – is already given to children to prevent meningitis. Various studies have shown that two doses of MenB, taken at least a month apart, can offer between 31% and 59% protection against gonorrhoea for at least three years.

Dr. Weil says that MenB's efficacy in preventing gonorrhoea hasn't been “widely trialled’ yet, but he believes the data so far is “convincing”. He also notes that ‘modelling data seems to suggest that this is an intervention that could save the NHS money in the long run”.

Despite the JCVI's recommendation more than a year ago, successive governments have shown no signs of preparing to implement a gonorrhoea vaccination programme. Ian Howley, CEO of health and wellbeing charity LGBT HERO, tells Huck that “we've seen this kind of heel-dragging before” with regard to HIV prevention drug PrEP.

The potentially game-changing pill became available on the NHS in 2017 – first in Scotland, then in other UK regions – following tireless lobbying from LGBTQ+ community groups. “It does seem as though [public health officials] won't engage with STI prevention methods unless we fight for them,” Howley says. “So I think we're all going to have to come together again to put pressure on those in charge.”

This pressure is already being applied by two leading sexual health charities. Last month, Terrence Higgins Trust and the British Association for Sexual Health and HIV (BASHH) issued a joint statement calling for the “urgent roll-out” of the vaccine. The latter’s president Professor Matt Phillips said: “Vaccines such as 4CMenB are not just good for individual patients, who are our top priority, but are also critical to tackle deepening inequalities and to reduce longer-term complications from infections such as gonorrhoea.”

In the meantime, individual patients can access MenB if they can afford to pay for it. Both Boots and Superdrug offer the vaccine to adults for £110 a dose. Joey Knock decided to fork out for two doses from Boots earlier this year after seeing an adult content creator post about the vaccine. “Because I seem to be quite susceptible to gonorrhoea and my symptoms can be quite severe, I figured it was worth a try because I was going to [fetish festival] Darklands at the end of February,” he says.

Joey booked his MenB jabs online after answering some “general health questions to check I'd be OK with the vaccine”. But even when he went into Boots to receive his doses, he faced no intrusive questions asking why he needed it.

10 months later, he feels it's “definitely been worth it” as part of his self-made package of sexual health protection. Joey also takes DoxyPEP – a dose of the common antibiotic doxycycline after condomless sex – because clinical studies have shown this cuts the risk of contracting syphilis, gonorrhoea and chlamydia. “I went to Darklands which I basically used as a four-day orgy and had no STI at all afterwards,” he says. “I did get a positive result for gonorrhoea in April but that's the last time I've had it.”

Like MenB, DoxyPEP isn't currently available on the NHS, but anecdotal evidence suggests it's already proving popular among MSM with multiple sexual partners. “It's really catching on and we're very, very close to formal implementation [on the NHS],” Dr Weil says.

But it almost goes without saying that the present situation is less than ideal. When it comes to preventing gonorrhoea, a two-tier system seems to be developing where some at-risk people have the money and knowledge to protect themselves, and others simply don't. For this reason, granting easy access to MenB on the NHS is absolutely vital sooner rather than later.

Terrence Higgins Trust's chief executive, Richard Angell OBE, tells Huck: “It's time for the government to commission this vaccine for those who most need it. The introduction of a MenB vaccination programme to prevent gonorrhoea would be a world first – we can and must lead the way on this.”

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