A vaccine targeting gonorrhoea will soon be rolled out on the NHS. This will make England and Wales the first two countries in the world to offer such a programme.
Author
- Bharat Pankhania
Senior Clinical Lecturer, Biomedical Sciences, University of Exeter
This move comes amid a sharp rise in gonorrhoea cases in England and increasing concern about antibiotic resistance . In 2023 alone, there were over 85,000 gonorrhoea diagnoses in England. Compared to 2012, where 25,525 cases were reported , this represents a 234% increase over the 11-year period.
Gonorrhoea is the second most common sexually transmitted infection in the UK. It's caused by the bacterium Neisseria gonorrhoeae and is spread via unprotected sex with an infected person.
Around 10% of men and nearly half of women who test positive for gonorrhoea exhibit no symptoms . This is why this STI is so transmissible, as people without symptoms may not seek testing or treatment - meaning they may unknowingly transmit the infection to their sexual partners.
For those that do experience symptoms, the most common signs of a gonorrhoea infection include unusual vaginal or penile discharge (which is usually yellow or green in colour), pain when urinating as well as pain and discomfort in the lower abdomen. In severe cases, the infection can spread throughout the body . In rare cases it can also lead to sepsis .
Untreated gonorrhoea infections can lead to many complications, including infertility , pelvic inflammatory disease (an infection in the reproductive organs) in women and epididymitis (inflammation of the testicles) in men.
The only way to treat gonorrhoea is using antibiotics . But an increase in antibiotic resistance is making treatment difficult .
Gonorrhoea prevention
Currently, the only way to prevent a gonorrhoea infection is by practising safe sex, such as using condoms during intercourse and limiting the number of sexual partners.
This new vaccine programme will offer an added layer of protection, especially for groups at high risk of acquiring the infection.
The vaccine that will be offered on the NHS is actually an existing childhood vaccine called 4CMenB (also sold under the brand name Bexsero). This vaccine is used to protect against meningococcal group B disease , which can cause life-threatening bacterial meningitis (inflammation of the brain and spinal cord) and sepsis.
The bacterium that causes gonorrhoea, Neisseria gonorrhoeae, is genetically closely related to Neisseria meningitidis - the bacterium that causes meningococcal disease. Their genome is between 80-90% similar.
The 4CMenB vaccine contains four antigens that are deployed against Neisseria meningitidis bacteria. An antigen is usually a small molecule that the body recognises as a foreign invader. This triggers the body to mount an immune response against the antigen by producing antibodies which neutralise the bacteria and eliminate the infection.
Two of the antigens found in the 4CMenB vaccine are found on the surface of both N gonorrhoeae and N meningitidis bacteria.
This is why using the 4CMenB vaccine for protection against gonorrhoea has progressed from theory to reality, with several studies showing it has a cross-protective effect.
Research has shown that the 4CMenB vaccine provides some protection against an infection from the Neisseria gonorrhoeae bacteria. On average, the vaccine is effective in preventing gonorrhoea between 32% and 42% of the time.
So while vaccination may reduce the chance of becoming infected with gonorrhoea, it's not an absolute protection. Nevertheless, this new vaccine programme means those who are vaccinated will have a lower risk of contracting gonorrhoea and experiencing any complications that may arise from an infection. Most importantly, it also means they are less likely to transmit the infection to others.
Vaccine programme
The main benefit of a vaccination programme will be a significant reduction in the number of gonorrhoea cases overall. This is especially important given the rise of antibiotic resistance is making it increasingly difficult to treat gonorrhoea infections.
It's also worth noting that a previous gonorrhoea infection offers no protection against future infection and reinfection. This is why the vaccine is beneficial, even if it is only moderately effective.
Eligible recipients , which includes gay and bisexual men who have a recent history of multiple sexual partners or a sexually transmitted infection, will be offered the vaccine through local NHS services from early August 2025.
Eligible patients will be identified via their local sexual health service, as well as through a general information campaign via the NHS. Patients will also be offered the mpox, hepitatis A and B and human papillomavirus vaccinations at the same time.
Vaccinating those at risk of contracting gonorrhoea will be more cost-effective and beneficial in the long run compared to vaccinating only those who have been diagnosed with gonorrhoea. Analysis led by Imperial College London has suggested the 4CMenB vaccine could prevent up to 100,000 cases of gonorrhoea and save the NHS over £7.9 million over the next decade if a high uptake is achieved.
Bharat Pankhania is affiliated with the Liberal Democrat Party. He is an elected councillor in the city of Bath and will be the Mayor of Bath on June 7 2025.
