Cases of Victorian sex disease skyrocketing – map shows infection risk

Government advisers have called for a vaccination programme to target the growing threat of a biblical disease that has hit a record high in the 21st-century.

The latest NHS data shows that there were more cases of gonorrhoea, the ancient sexually transmitted infection, in England in 2022 than at any time since records began more than 100 years ago. Cases have been rising over the last few years, before dropping off during the lockdowns and isolation of the pandemic, only to return to a record high of 82,500 cases last year. That was 50% more than the previous year and 16% higher than before the pandemic in 2019.

Now the Joint Committee on Vaccination and Immunisation (JCVI) has advised the government to offer a targeted vaccination programme to prevent the spread of gonorrhoea. The JCVI says evidence shows the 4CMenB vaccine – which is currently used to protect children from meningitis and septicaemia – offers some protection against gonorrhoea.

However, with effectiveness documented at between 33% and 42%, it wouldn’t provide complete protection against the disease, but would prevent some cases.

Professor Andrew Pollard, Chair of the JCVI, said: “Introducing a MenB vaccination programme to prevent gonorrhoea in England would be a world first and should significantly help to reduce levels of gonorrhoea, which are currently at a record high.”

Katy Sinka, head of sexually transmitted infections at UKHSA, added: “A vaccination programme to impact on gonorrhoea cases would be a hugely welcome intervention to ensure we are better prepared to address this increasing threat. We saw a rapid rise last year with more cases than ever before and with gonorrhoea becoming increasingly resistant to antibiotics, tackling this infection is a serious concern.”

Symptoms of gonorrhoea, formerly known as “the clap”, include a thick green or yellow discharge from the vagina or penis, pain when peeing and, in women, bleeding between periods. It is normally spread by having unprotected sex, or in some cases by sharing sex toys, but it can also be passed from a pregnant woman to her baby. Without treatment, gonorrhoea can cause permanent blindness in a newborn baby.

It was first described by Albert Neisser in 1879, but it can be traced back to the earliest records of the human race and even to biblical times. The Romans, Jews and Arabs all have documents referring to gonorrhoea and each society had their own description of symptoms and treatment. As long ago as 130 AD the Roman physician Galen described the disease as an “involuntary escape of semen”.

The disease is thought to be referenced in the bible, particularly in the Old Testament Book of Leviticus, which warns: “The man that hath an issue of seed, shall be unclean.” Leviticus offers instructions to prevent its spread including the need for prayer “that he may be cleansed of the issue of his seed”.

Now, in the 21st Century, the JCVI has advised that a vaccination programme should primarily target gay and bisexual men and other men who have sex with men, who have the highest rates of gonorrhoea. But efforts should also be made to ensure the vaccine is offered to heterosexual or other people at “equivalent risk”. The risk of contracting gonorrhoea is around three times higher in London than anywhere else in England, with rates in the capital and the surrounding Greater London at 383 infections per 100,000 people.

The next highest risk is in the North West (133 infections per 100,000 people) and then Yorkshire and the Humber (120). The lowest rates are in the East of England (66). Figures for local authority areas show that Lambeth has the biggest problem with gonorrhoea. Last year there were 3,875 infections documented, a rate of 1,220 cases for every 100,000 people. That means the equivalent of one in every 100 people living in the London borough caught gonorrhoea last year, although some cases may relate to individuals contracting the infection multiple times.

The next highest rates were in the City of London (1,149 per 100,000 population), the “Square Mile” banking and financial district, and then Southwark (1,016). Of the top 20 areas with the highest rates, 16 were in London. Outside the capital, Liverpool had the highest rates of gonorrhoea (317 per 100,000 population), followed by Manchester (312) and Nottingham (308).

The lowest risk of contracting gonorrhoea was in North Norfolk where there were just 21 cases for every 100,000 people.