An 11-year-old Austrian girl, with no history of sexual contact whatsoever, contracted gonorrhea after a recent family trip.
Caused by the bacterium Neisseria gonorrhoeae, gonorrhea is a sexually transmitted disease (STD) that mostly affects men. Women often don’t develop symptoms. However, some can present with burning micturition, bleeding between periods, pain during sexual intercourse, and vaginal discharge. The disease can also infect the rectum, joints, eyes, or throat. If left untreated, the bacteria can ascend the genital tract and cause septicemia or arthritis in individuals. Although the majority of cases are a result of sexual transmission, the infection can also occur from nonsexual transmission through fomites or bathing in contaminated water. A recent case report highlights an unusual case of gonorrhea in an 11-year-old girl.
The 11-year-old had presented to her paediatrician with a complaint of burning sensation in her genitals and discharge. Her symptoms had not resolved despite the use of an over-the-counter antifungal cream. Upon examination, the paediatrician did not find any sign of sepsis, fever, or an elevated pulse. Moreover, her vaginal examination was unremarkable. However, the doctor took a vaginal swab and it returned positive for Neisseria gonorrhoeae.
In young patients, the possibility of sexual abuse is always the first thing explored. However, the girl’s family members all tested negative, and she denied any sexual contact whatsoever. The only thing that stood out in her history was a recent visit to a hot pool during a family vacation to Italy. Moreover, her symptoms had also begun two days after bathing in the hot pool.
How Did a Hot Pool Transmit an STD?
In August 2020, the 11-year-old had visited the crater lake Specchio di Venere (“Mirror of Venus”) on Pantelleria Island, Italy. There she spent an hour soaking in a shallow hot pool located at the lake’s edge. While she was there, multiple people frequented the pool; however, the girl was never alone in the pool. She was accompanied by her father, whereas her mother and younger sister soaked in another pool nearby. Moreover, throughout the vacation, the family was constantly together, denying any opportunity for sexual abuse.
According to study authors, hot pools have a temperature close to the body’s, helping the survival of the bacterium responsible for causing gonorrhea. Moreover, the water is slightly acidic and contains minerals and organic particles that serve as potential substrates for biofilms. They, therefore, suggest that bathers take a shower with an antibacterial soap immediately after coming out of the pool. Moreover, hot pools should have a sign for visitors, warning them of potential contaminants.
The 11-year-old underwent treatment with ceftriaxone infusion, followed by oral azithromycin. She made an uneventful recovery and carried on with her normal day-to-day routine.
Goodyear-Smith, F., Schabetsberger, R. Gonococcus infection probably acquired from bathing in a natural thermal pool: a case report. J Med Case Reports 15, 458 (2021). https://doi.org/10.1186/s13256-021-03043-6