Gonorrhoea Vaccine Tackles STI Rise

England Confronts Gonorrhoea Surge with World-First Vaccination Drive

NHS England initiates a pioneering immunisation strategy, deploying a vaccine for meningitis B to curb escalating gonorrhoea cases and combat rising antibiotic resistance; the programme will prioritise high-risk groups.

In an unprecedented public health move, NHS England is set to roll out the world's premier routine vaccination programme targeting gonorrhoea. This initiative, commencing in August, aims to curtail the alarming rise in infections. It also seeks to address the growing challenge of antibiotic-resistant strains of the condition spread through sexual contact. The decision follows recommendations from the Joint Committee on Vaccination and Immunisation (JCVI). This action occurs as England grapples with its most substantial recorded gonorrhoea rates since 1918.

The health service will not provide the inoculation universally. Instead, it will concentrate on individuals considered at most significant risk. This group primarily encompasses men who identify as gay or bisexual, and other men who have sex with men. Particular focus will be on those with a recent background involving numerous sexual encounters or a previous diagnosis of a sexually transmitted condition.

A Record Rise in Infections

Recent data from the UK Health Security Agency (UKHSA) paints a stark picture of the gonorrhoea situation in England. During 2023, diagnoses surged to over 85,223 cases. This marked a significant 7.5% increase from the 79,268 cases reported in 2022. This figure represents the largest quantity since record-keeping initiated over a century ago; it is triple the number observed in 2012. Overall diagnoses for sexually transmitted conditions in England also rose by 4.7% in 2023, totalling 401,800. The escalating numbers highlight an urgent requirement for new preventative measures. The British Association for Sexual Health and HIV (BASHH) described the rising rates of sexually transmitted conditions as a "concerning indicator" of the severe pressure on facilities offering sexual well-being support.

Understanding Gonorrhoea's Impact

Gonorrhoea, an illness stemming from the bacterium Neisseria gonorrhoeae, frequently presents without symptoms. This is particularly true for infections of the throat, vagina, or rectum. This characteristic makes regular testing crucial for sexually active individuals with new or casual partners. When indications do appear, their manifestations might involve unusual discharge from the genitals, pain during urination, and localised swelling. If left untreated, gonorrhoea can lead to serious and irreversible health complications. In women, it can spread to the reproductive organs, causing pelvic inflammatory disease (PID). PID can result in ectopic pregnancies, chronic pelvic pain, and infertility. In men, untreated gonorrhoea may cause epididymitis, a swelling of the tubes near the testicles, potentially leading to infertility. The infection also elevates the possibility of HIV transmission.

A Novel Use for an Existing Vaccine

The inoculation NHS England will deploy did not initially have gonorrhoea as its target. It is the 4CMenB immunisation, also known as Bexsero. Babies in the UK currently receive this to protect against meningitis B. The bacteria responsible for meningitis B and gonorrhoea, Neisseria meningitidis and Neisseria gonorrhoeae respectively, are closely related genetically. This similarity allows the MenB immunisation to offer a degree of cross-protection against gonorrhoea. Observational studies and research have suggested that the MenB inoculation can diminish gonorrhoea occurrences by approximately 30% to 40%. While this level of effectiveness will not entirely remove the danger, health officials believe it can significantly impact infection rates.

Targeting and Implementation Strategy

The JCVI recommended a focused rollout, and NHS England has adopted this advice. The programme will primarily concentrate on gay, bisexual, and other men who have sex with men (GBMSM) who have multiple partners or a background of sexually transmitted conditions. These groups experience a disproportionate burden of gonorrhoea. Data also reveals higher rates among individuals aged 16-25 and those of Black and Caribbean heritage. Clinicians working in centres for sexual wellness will possess the discretion to provide the immunisation to other individuals they assess to be at a comparably elevated danger level. Local authorities and NHS centres for sexual wellness will identify eligible individuals and invite them for vaccination, with the programme starting in early August.

The Growing Threat of Antibiotic Resistance

A critical factor driving the new vaccination programme is the escalating problem of antibiotic resistance in Neisseria gonorrhoeae. Gonorrhoea has a notorious history of developing resistance to antibiotics used for its treatment. This began with sulphonamides in the 1940s and continued with penicillin, tetracyclines, and fluoroquinolones. Ceftriaxone, the current frontline antibiotic, now faces reduced susceptibility. UKHSA data from January 2024 to March 2025 showed 17 instances of ceftriaxone-resistant gonorrhoea, compared to 16 in the preceding two years. More concerning is the rise in extensively drug-resistant (XDR) strains. These are resistant to ceftriaxone and second-line treatments. Nine XDR cases were reported between January 2024 and March 2025, up from five in the previous two years. Many of these resistant cases connect to travel, particularly to and from the Asia-Pacific region. This growing resistance raises fears of untreatable gonorrhoea, making prevention even more crucial.

Economic Projections and Public Health Gains

An analysis projecting the potential impact of the vaccination programme came from Imperial College London. Their models suggest that with high uptake, the 4CMenB immunisation could prevent up to 100,000 gonorrhoea occurrences within the upcoming ten-year span. This reduction in cases could also translate into significant financial savings for the NHS, estimated at nearly £8 million during the same period. The immunisation itself has a price of approximately £8 for each administration. By averting infections, especially those that could become difficult or impossible to treat, the programme aims to alleviate pressure on sexual wellness facilities and reduce long-term health complications and their associated costs.

Image Credit - BBC

Expert and Campaigner Perspectives

Sexual health professionals and campaigners have largely welcomed the announcement. Professor Matt Phillips, BASHH President, described the programme, stating it represents exceptionally positive news and signifies a pivotal juncture for sexual well-being in England. He highlighted that gonorrhoea identifications have reached their most significant point since reporting started. He added that the vaccine possesses the capability to assist in reversing this trend. Max, an advocate for sexual well-being, informed BBC Newsbeat about his personal experience of contracting gonorrhoea twice inside a twelve-month period. He expressed his definite intention to receive the immunisation. He believes the initiative is excellent news and will relieve pressure on clinics. Katie Clark, from the Terrence Higgins Trust, also lauded the decision, calling it a substantial victory. Dr Amanda Doyle, NHS England's National Director for Primary Care and Community Services, stated the launch marks a considerable progression. She stressed it will be crucial in safeguarding individuals and preventing the transmission of infection, including antibiotic-resistant strains.

Logistical Rollout and Combined Vaccinations

The gonorrhoea vaccination programme is scheduled to begin in August. Establishments for sexual wellness, commissioned by local authorities, will administer the vaccine. NHS England confirmed that local providers will identify and contact eligible individuals in the coming weeks. When individuals attend their appointments for the gonorrhoea jab, they will also receive offers for other relevant vaccines. These include vaccinations for mpox (formerly monkeypox), Human Papillomavirus, known as HPV, and hepatitis A and B. This provides a more comprehensive approach to sexual health protection. This integrated approach aims to maximise protection for those most at risk.

The UK-Wide Vaccination Landscape

While England spearheads this initiative, other UK nations are also addressing the gonorrhoea threat. Public Health Scotland has indicated its active development of plans to introduce its own vaccination programme tailored for highly susceptible persons. Similarly, the Department of Health in Northern Ireland is considering the issue; they anticipate a statement soon. Sexual Health NI indicates that while a gonorrhoea vaccine is not currently available, a targeted programme is planned for the future, also utilising the MenB vaccine due to its cross-protective properties. Healthcare authorities in Wales have also been consulted about their intentions regarding a similar programme. This suggests a potential for a more unified approach across the UK in tackling this sexually transmitted condition.

Global Context and Vaccine Development Efforts

England's programme is a global first for routine gonorrhoea vaccination. However, the challenge of gonorrhoea and its increasing antimicrobial resistance (AMR) is a global concern, prompting international efforts to find solutions. The World Health Organization (WHO) has identified Neisseria gonorrhoeae as a priority pathogen due to its AMR. The WHO has emphasized the urgent need for new interventions, including vaccines. The WHO's Global STI Vaccine Roadmap outlines key actions to advance vaccine development. Globally, an estimated 82.4 million new gonorrhoea infections occurred in 2020. The development of a specific gonorrhoea vaccine has been challenging due to the bacteria's ability to rapidly change its surface structures. The cross-protection observed with MenB vaccines offers a promising, albeit partial, interim solution.

Addressing Vaccine Efficacy and Public Communication

The 30-40% efficacy of the MenB immunisation against gonorrhoea means it does not provide complete protection. Clinics for sexual wellness will need to manage expectations. They must communicate clearly that the vaccine reduces risk but does not remove it entirely. Safe sex practices, including consistent and correct condom use, remain paramount in preventing gonorrhoea and other sexually transmitted conditions. Professor Andrew Pollard, who leads the JCVI, acknowledged the partial efficacy. However, he emphasized that the immunisation possessed significant value and could still produce a substantial overall effect due to the high number of cases. Open conversations about the vaccine's benefits and limitations will be essential for informed decision-making by eligible individuals.

The Ongoing Search for New Antibiotics

Alongside preventative measures like vaccination, the search for new treatments for gonorrhoea continues. The diminishing effectiveness of existing antibiotics makes this research critical. Recently, scientists reported promising results for a new antibiotic, gepotidacin. Funded by GSK, trials showed gepotidacin was as effective as existing treatments. It could tackle some drug-resistant strains. It works by blocking essential enzymes needed for gonorrhoea to replicate. Another oral antibiotic, zoliflodacin, has also shown promise in phase 3 clinical trials. If approved, it could represent the premier new antibiotic specifically for gonorrhoea in decades. These developments offer hope but underscore the relentless nature of bacterial resistance.

Ethical Considerations in Targeted Vaccination

Targeted vaccination programmes, while often the most cost-effective and efficient use of resources, can raise ethical considerations. Issues such as ensuring equity of access, avoiding stigmatisation of targeted groups, and maintaining privacy are important. For HPV vaccination programmes, for example, discussions have included parental rights, gender equity, and concerns that vaccinating against a sexually transmitted condition might be perceived as encouraging promiscuity. While the primary goal of the gonorrhoea vaccine programme is public health by reducing transmission and protecting vulnerable individuals, clear communication and community engagement will be important to address any potential concerns and ensure fair implementation. The focus on those at highest risk aims to maximise the public health benefit with available resources.

Long-Term Protection and Future Outlook

Questions remain about the duration of protection the MenB immunisation will offer against gonorrhoea. It is also unclear whether booster jabs will be necessary. Ongoing monitoring and research will be vital to assess the long-term effectiveness of the programme and adapt strategies as needed. The decision to implement this vaccination programme arrived close to one and a half years after the JCVI initially recommended it. While some advocates for sexual well-being had voiced disapproval regarding that extended delay, the eventual rollout has been broadly welcomed. The initiative represents a significant new tool in the fight against a resurgent and increasingly resistant infection. Its success will depend on uptake, continued vigilance, and a multi-faceted approach to sexual health that includes education, testing, and safe sex practices.

A Multi-Pronged Approach to Sexual Health

The introduction of the gonorrhoea vaccine complements other ongoing sexual health initiatives. The concurrent offering of mpox, HPV, and immunisations for hepatitis demonstrates a holistic strategy to protect at-risk populations from multiple infections. Facilities for sexual wellness face significant demand, with consultations in England reaching a record 4.61 million in 2023, a 44.3% increase from 2019. Effective prevention strategies like vaccination can help alleviate this pressure. BASHH continues to advocate for a comprehensive national sexual health strategy. This is to ensure services can meet rising demand and address health inequalities effectively. Sustained investment and a strategic approach are crucial for improving sexual health outcomes across the population. The fight against gonorrhoea and other sexually transmitted conditions requires continuous adaptation and innovation.