Sexually Transmitted Infections

Clinical conditions Scotland

Sexually transmitted infections (STIs) have a significant impact on the health of Scotland. STIs cause mortality via human immunodeficiency virus and human papilloma virus; pelvic inflammatory disease and reproductive complications via gonorrhoea and chlamydia yet also infect the unborn foetus by syphilis and herpes.

Figures released by the Information Services Division of National Services Scotland (part of NHS Scotland) in January 2014, highlight that across all age groups, there has been a 43 per cent increase in STIs since 2003. The figures, covering chlamydia, herpes and gonorrhea, show a rise over this period from 15,601 to 22,306. Most interesting to me, was that the number of Scots diagnosed with gonorrhea rose by 133 per cent from 808 in 2003 to 1884 in 2012.

Antimicrobial resistance is a serious issue in gonorrhoea treatment and has caused the last-line drugs (ceftriaxone combined with azithromycin) to become the standard therapy in the UK.  There is no reserve drug available if ceftriaxone resistance – already found in France, Spain and Japan – spreads across Scotland.  Without dependable therapy, many Scottish women with gonorrhoea will remained untreated and develop the associated pelvic inflammatory disease, ectopic pregnancy, infertility and even disseminated infections in synovial joints.

Between 1929 and the 1970s, pharmaceutical companies developed more than twenty novel classes of antimicrobials. Since the 1970s, only two new categories of antimicrobials have arrived. This has caused Gregory Daniel to write about market failure in antibiotic development.

Market failure is an issue as, when used appropriately, a single £100 course of antibiotics could treat an infectious disease like gonorrhoea. However, being clinically effective after short-term use has the unfortunate consequence of making antimicrobials significantly less profitable than the drugs used in – for example – cancer therapy, which can cost £20,000 per year.

In September 2013 the Department of Health published its UK Five Year Antimicrobial Resistance Strategy.[11] The strategy called for “work to reform and harmonise regulatory regimes relating to the licensing and approval of antibiotics”, better collaboration “encouraging greater public-private investment in the discovery and development of a sustainable supply of effective new antimicrobials” and states that “Industry has a corporate and social responsibility to contribute to work to tackle antimicrobial resistance.”

As socialists, I think that we should have three major objections to these statements. One, managers in the pharmaceutical industry have no responsibility to contribute to work tackling antimicrobial resistance. They have a responsibility to make profit for shareholders or be replaced. It is the state that has the responsibility for the protection and wellbeing of its citizens.
Secondly, following last years’ horsemeat scandal we, as socialists, should object to companies cutting corners in attempt to increase profits. This leads on to the final objection, that inpromoting public-private collaboration all the state is doing, is subsidising share holder profits by reducing their financial risk.

Mariana Mazzucato in her 2013 book, THE ENTREPRENEURIAL STATE, discusses how the state can lead innovation and criticises the risk and reward relationships in current public-private partnerships. I feel that significant advances in the prevention, diagnosis and treatment of STIs could be made by undertaking basic scientific research and we in Scotland should campaign for state funded researchers working within the public sector.

These scientists could study the mechanisms of antimicrobial entry into bacterial cells or screen natural antibiotic compounds to develop novel antimicrobials but also develop technologies such as point-of-care diagnostic devices that allow healthcare professionals to prescribe the most effective therapies. Point-of-care diagnostic devices like these would also help to tackle the development of antibiotic resistance in diseases like gonorrhoea by preventing the use of inappropriate antibiotics in patients who do not require them.
In addition to these, scientists could also develop vaccines. The human papilloma virus vaccine shows the great potential of this field and there is no reason why this approach could not be adopted for gonorrhoea but also additional STIs like chlamydia and syphilis. With regard to other STIs, our current therapy options for human immunodeficiency virus are very expensive and drug resistance is a continual threat. Development of a vaccine would reduce cost to the NHS and mortality in Scotland but also allow the UK to provide greater assistance with international development.

The state could choose to build laboratories researching STIs in areas of Scotland with high unemployment and that have been neglected by private sector investment, to help promote regional recovery. Even more radically, if novel antibiotics are produced for their social good rather than the financial return from the volume sold, they can be reserved indefinitely – as a last-line drug – until a time of crisis.

Finally, with regard to democracy, patients and the general public in Scotland could have a greater say as to which STIs are researched and it would help us shift away from our reliance on the market to provide what society needs. As we all know the market responds, not to what Scotland needs, but to what will create the most profit.
Scott Nicholson is a PhD Student, University of the West of Scotland

This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014