World's first gonorrhoea vaccine begins rollout

The UK's National Health Service is rolling out a world-first vaccine programme to help tackle the problem of gonorrhoea. Rates of this bacterial infection have climbed worldwide at an alarming rate in recent years, and a high fraction of the infections are being caused by heavily drug-resistant strains of the microbe. It’s hoped the move, which will use the vaccine developed for the close relative of gonorrhoea, the meningococcus bacterium that causes meningitis, will prevent thousands of new cases over the next decade. Shamez Ladhani and Hamish Mohammed are at the UK Health Security Agency. Hamish explains first the scale of the issue confronting us…

Hamish - The problem is gonorrhea, which is a sexually transmitted infection. It's spread through sexual contact. It's caused by infection with the bacterium Neisseria gonorrhea, and symptoms include painful urination and an abnormal genital discharge. But it's important to note that many people with gonorrhea may not have any symptoms. Now, symptoms of gonorrhea have been recognized for centuries in ancient Egyptian, Chinese, and Roman texts, as well as the Old Testament. It's a serious infection, and it could also result in a number of adverse clinical complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Also, the bacteria that causes gonorrhea is really agile. It's developed resistance to every class of antibiotics used to treat it over the decades. So antibiotic resistance for gonorrhea is a globally recognised public health concern. Now, in England, we've been detecting record numbers of gonorrhea diagnoses in recent years, with over 85,000 diagnoses in 2023. And that 85,000 total is the highest annual number since records began a long time ago in 1918.

Chris - What are you proposing? Apart from obviously monitoring, surveillance is really important to keep on top of these sorts of trends. But what are you proposing by way of intervention?

Hamish - The reason why we're here today is about the fantastic opportunity that presents itself for a gonorrhea vaccination program in England to reduce gonorrhea risk.

Chris - And Shamez, can you tell us what that intervention is and how it's proposed to work?

Shamez - We've been trying to make a vaccine against gonorrhea for more than 100 years, and we have failed every time. And there isn't any vaccine out there that even looks promising. But about 12 years ago, a vaccine was licensed against meningitis and septicemia. Fortuitously, the meningococcus which causes meningitis and septicemia is very closely related genetically to the gonococcus, which causes gonorrhea. And other countries that have used this vaccine for teenagers and young adults have found that this vaccine also gives 40% protection against gonorrhea for at least four years, and more data are coming through. So even though the vaccine is not licensed against gonorrhea, we feel that because of the problems that we have at the moment with control of gonorrhea and antibiotic resistance, we should be implementing a vaccine that will help reduce the burden of disease, potentially transmission of the disease, and actually give the sexual health services a bit of a break by reducing the number of treatments and investigations that they have to do.

Chris - You say that it reduces the risk of catching gonorrhea by 40%. Is there a chance though, that it could push some cases under the carpet and turn them into asymptomatic cases, so we miss them, the people don't even know they've got it, but they're nevertheless infected and could carry on passing it on?

Shamez - It is possible. We need more data. But this is one of the fields that if you don't use a vaccine, we won't learn from it. We are going to be the first country in the world to offer the vaccines to groups that are at high risk of gonorrhea. And what we are hoping is by being at the front end, we will be able to monitor vaccines and infection rates. And that will teach us a lot more about the vaccines, not only how best to use them, but potentially to develop new generation vaccines based on the same vaccine technology so that we get better protection against gonorrhea.

Chris - Hamish, do you know who those groups that Shamez is referring to are, who are at highest risk and therefore are your target for this intervention?

Hamish - The gonorrhea vaccination programme will primarily focus on gay and bisexual men with markers of increased risk for gonorrhea, such as a recent bacterial STI infection. Bacterial STIs would include gonorrhea as well as syphilis. Now, the reason why this is the primary focus of the vaccination programme is because gay and bisexual men comprise less than 5% of the population, but they represent just under 50% of gonorrhea diagnoses each year. So while eligible gay and bisexual men will be offered the vaccine at sexual health services, clinicians at these services will have clinical discretion to offer the vaccine after an assessment of gonorrhea risk to other individuals as well.

Chris - And Shamez, when will you know it's working?

Shamez - We're hoping to have the first results within 12 months, because what we are hoping is that if we can demonstrate the same effect that they have seen in other populations, which is not the high risk populations, other countries will be tempted to offer the programme to their populations as well, and that way you can have a major impact. As you can imagine, many other countries have similar problems to us, and the rising problem of antibiotic resistance is a global one. So, we will try and get the data out as soon as possible so that other countries can use that information to make decisions for their own countries. I'm very optimistic we'll have results within 12 months of starting the programme.