Gonorrhea: comeback king

"I'd only ever actually heard of the clap in the context of rich business people going to Asia on holiday, coming back and infecting their wives." This is one of many such comments on a gonorrhea forum on the Internet, and it reflects some long-standing prejudices. Anyone can catch gonorrhea - you don't have to be rich or in business, and the disease is not confined to Asia.

Berlin's Robert Koch Institute estimates the number of gonococcal infections in Germany at between 10,000 and 20,000 each year.

It's difficult to be more precise, as since 2000 cases of gonorrhea no longer have to be reported (except in the state of Saxony).

The traditional sexually transmitted infections and diseases (STIs, also known as STDs) were thought to have been brought under control. But it seems that is no longer the case. Gonorrhea is currently the third most common STI in the world.

"It's not just gonorrhea - all the STIs are making an unexpected comeback," says Professor Norbert Brockmeyer, an HIV/AIDS expert at Ruhr-Universität in Bochum. He is also the president of the German STI Society. "It's very surprising because - generally speaking - more people are now using condoms."

Brockmeyer says it is likely that the infection is being spread by people who are very sexually active. Men who have sex with men are particularly at risk.

Infection can lead to infertility

Gonorrhea is usually transmitted during sexual intercourse: anally, vaginally, or orally.

"The prevention campaigns for HIV and other sexually transmitted diseases are different," Brockmeyer explains. "You can even become infected from the touch of a finger. If someone has [infected] vaginal fluid on their fingers, for example, they can infect you with syphilis or gonorrhea."

The cervix, rectum, throat, or mucous membranes of the urethra can be affected. Within a week of infection, men will usually notice a pus-filled discharge oozing from the urethra. In some cases, gonorrhea can result in infertility.

In women, the infection generally presents itself in a similar way to men. However, it may be that women experience no symptoms at all. And that can increase the risk of the disease spreading as it may well go untreated.

"It can lead to pelvic inflammation," explains Dr Viviane Bremer of the Robert Koch Institute, "then a blockage of the fallopian tubes. That means the woman is no longer able to have children."

If a pregnant woman becomes infected with gonorrhea, she risks passing the infection on to the newborn.

"In babies, gonorrhea especially affects the eyes," says Bremer.

A newborn baby will start to show symptoms just days after birth: its eyelids become swollen, and the eyes are very sensitive to light. The infection is treated with antibiotics.

Resistance is increasing

Antibiotics have long been the preferred method of treatment. But international monitoring programs now show that the disease is increasingly becoming resistant to this kind of medication.

Bremer explains that it is still possible to treat it with a combination of antibiotics, but that this could ultimately lead to a situation where it is no longer possible to treat a straightforward infection.

At present, though, there are no alternatives. Development of a vaccine is still only a distant prospect.

Germany's STI Society - the Society for the Promotion of Sexual Health - has published some guidelines. One recommendation is to administer a one-off, high-dose combination of two different antibiotics, ceftriaxone and azithromycin.

As well as developing effective therapies, the STI Society is also working on effective prevention. They want people to become as familiar with the abbreviation 'STI' as they now are with HIV. The HIV infection rate has been relatively stable for about five years and this is partly as a result of repeated awareness campaigns.

Germany has the lowest HIV infection rate in the world, says Brockmeyer. "In the past few years we've been focusing on HIV. Now, though, you'll often see campaigns that address familiar diseases like gonorrhea and syphilis."

"Great freedom: love.lust.life."

Most people these days know what HIV and AIDS are, but they don't necessarily know anything about other sexually transmitted diseases. They probably aren't familiar with the symptoms or potential risks of chlamydia, hepatitis B, genital herpes, HPV, syphilis or gonorrhea. The experts say information campaigns are urgently needed - not least because people are far more at risk of contracting HIV if they have already been infected with another STI.

In Berlin, an interactive exhibition has just opened, specifically designed to inform the public about STIs. It was organized by the BZgA, the Federal Center for Health Education. In "GREAT FREEDOM - love.lust.life." eight people tell their stories, providing an insight into sexually transmitted infections, how to deal with them, and how to protect yourself against them.

The German STI Society's Norbert Brockmeyer is impressed with the interactive displays and the stories behind the numbers. "I'm sure that's something that will grab young people's attention - and they're the ones we want to reach."

Gone are the days when STIs were a taboo subject, associated only with grubby affairs and prostitution. Initiatives like these aim to raise awareness of how common STIs can be, and inform people as to how they can protect themselves and others.