Neisseria meningitidis and Neisseria gonorrhoea share a genetic homology of 80 to 90%, raising the potential for cross-protection from meningococcal B vaccines against gonorrhea. Gonorrhea, caused by Neisseria gonorrhoea, is the second most diagnosed STI in England, for example, with approximately 80,000 cases yearly.
It spreads through various sexual activities, even when asymptomatic.
Complications include pelvic inflammatory disease, ectopic pregnancy, infertility, and painful infections in men. The escalating antimicrobial resistance worldwide makes gonorrhea a significant public health concern. Ceftriaxone is the current first-line therapy in the UK, with a rise in resistant cases associated with travel to the Asia-Pacific region.
The UK’s Joint Committee on Vaccine & Immunization (JCVI) advocates using Bexsero and 4CmenB to counter rising gonorrhea rates, focusing on high-risk groups like gay, bisexual, and other men who have sex with men, transgender women, and those with a recent history of bacterial STIs or sex work. Vaccination decisions, guided by a sexual health professional's risk assessment, recommend delaying until infection cure. The UK Health Security Agency recognizes the escalating threat of gonorrhea and supports the potential impact of vaccines.
The JCVI also suggests routine mpox vaccine use for at-risk individuals, awaiting approval from the Department of Health and Social Care to address antibiotic-resistant gonorrhoea.
Bexsero's genetic similarity to gonorrhea-causing bacteria hints at potential protection, with observational studies estimating effectiveness between 33% and 42%.
A National Institute of Health (NIH) funded randomized controlled trial is underway in the US, Thailand, and Africa, with enrollment expected to conclude by mid-2024. Experts express concerns about off-label use without conclusive clinical trial data, emphasizing the need for robust evidence. The JCVI report underscores uncertainties regarding the vaccine's duration of protection and emphasizes the importance of communicating ongoing infection risk post-vaccination.
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