Doctors say they’ve documented an unusual case of gonorrhea in an 11-year-girl from Austria, one with no evidence of sexual transmission. As near as they can tell, the girl caught it from swimming in a communal hot spring while vacationing in Italy. Thankfully, the infection was successfully treated with antibiotics once discovered.
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae. Symptoms can include a burning sensation and pain around the genitals, especially when peeing, though many victims may not experience any signs of infection. If not treated promptly, it can raise the risk of chronic health problems like infertility as well as the risk of catching other sexually transmitted infections. Unfortunately, gonorrhea has become harder over time to treat, as some strains have gained resistance to most or all of our frontline drugs.
Though gonorrhea is one of the most common STIs around, the doctors behind this recent case say that sex probably wasn’t how their young patient contracted it.
According to their report, published in September in the Journal of Medical Case Reports, the girl had been on vacation with her family in Italy when she began to experience vaginal burning and discharge. She took over-the-counter antifungal cream, which seemed to help a bit, but not completely. Two weeks later, the family returned home to Austria, where she saw a local pediatrician and genital swab samples were taken. Tests then confirmed that she had contracted gonorrhea.
Obviously, the presence of gonorrhea in a minor sets off alarm bells, given the possibility of sexual abuse. But none of the girl’s family members tested positive for the bacteria, and the girl denied having had sex. Moreover, the girl had spent all her time with the family on the holiday, and the doctors were unable to find any evidence or opportunity for recent sexual transmission to have caused her infection.
Two days before her symptoms began, however, the girl and her family had traveled to the famous crater lake Specchio di Venere (“Mirror of Venus”) on Italy’s Pantelleria Island. After swimming in the lake, the girl soaked for an hour in one of the nearby shallow hot pools near the lake’s edge. She was always with her father and others during that time, according to the report.
Gonorrhea bacteria prefer hot and humid environments, the sort our genitals can usually provide with ease. But the hot springs of Specchio di Venere, which nearly match our body temperature, could serve as a suitable home for gonorrhea bacteria that’s wandered away from an infected swimmer, the doctors say, at least for a while. And these contaminated waters are almost certainly how the young girl contracted her infection.
“Our case serves to illustrate that the very uncommon diagnosis of gonorrhea in a child may be the result of nonsexual transmission of the infection, and that contaminated hot pools are a very rare source of infection that should be considered,” they wrote.
The girl was prescribed antibiotics, and her remaining symptoms faded away after a few days, while the infection cleared up within a month’s time. The girl made an “uneventful recovery and remains well,” the authors wrote.
It’s a common urban legend that people will mistakenly believe (or falsely claim) their STI was caught outside of having sex, such as by sitting on a public toilet seat or from swimming in a pool. But the authors cite other documented cases where outbreaks of nonsexually transmitted gonorrhea have likely occurred, including at communal baths. Lab experiments, meanwhile, have demonstrated that gonorrhea can survive for a few hours on commonly shared fabrics like towels, leaving open another route of transmission.
While most cases of gonorrhea will indeed be transmitted through sex, the possibility for nonsexual transmission should be kept in mind, the authors say. For minors who contract gonorrhea, sexual abuse should always be considered the most likely explanation, but it’s important to throughly investigate all potential causes, they added.
Most swimming pools are artificially chlorinated, which does cut down the risk of contracting infectious diseases. But people who visit natural hot pools should be made aware of the rare risk of contamination from those with gonorrhea, which can infect the eyes as well as genitals, according to the authors. Nearby showers and antibacterial soap should be provided to those who visit these springs, the authors wrote, which should further reduce the risk of being infected by germs that could survive in these waters, including E. coli.