11-year-old girl contracts gonorrhea when bathing in a thermal pool of thermal waters during her holidays in Italy
An 11-year-old girl contracted gonorrhea from a natural thermal pool in Italy while on vacation, doctors revealed.
The boy, from Austria, was bathing on the edge of the ‘Mirror of Venus’, a lake fed by volcanic hot springs on the island of Pantelleria, off the coast of Sicily.
It is believed that he contracted the infection, which is usually sexually transmitted, from water, which had been used by a person with gonorrhea.
The temperatures in the swimming pools can be close to body temperature and, in this case, could have provided a way for the bacteria to infect the girl, experts said.
Bathing in hot springs is a popular pastime in many British holiday resorts such as Italy, Turkey and Iceland.
With more Britons going on vacation now that Covid travel restrictions have been eased, experts say people should be aware of the dangers of using these pools.
The picturesque ‘Mirror of Venus’, also known as Specchio di Venere / Lago di Venere, is a tourist hotspot famous for the hot pools on its shores. But this was also the place where an 11-year-old girl contracted gonorrhea from sharing a pool with an infected stranger.
The official NHS guidance states that gonorrhea cannot be contracted by sharing water, but there are historical cases of this happening, experts say.
In the case, detailed in the Medical Case Report Magazine, the Austrian girl was on vacation with her parents and her seven-year-old sister in August 2020.
WHAT ARE THE SYMPTOMS OF GONORRHEA?
More than 35,000 people a year are infected with gonorrhea in England, including a record number of baby boomers. Only chlamydia and genital warts are more common.
Figures show that 78 million people worldwide contract gonorrhea, which can often remain asymptomatic for weeks, each year.
Symptoms usually appear two weeks after infection, but can remain hidden for many months.
In women, symptoms of gonorrhea can include:
- an unusual vaginal discharge, which may be thin or watery and green or yellow in color
- pain or burning sensation when urinating
- pain or tenderness in the lower abdominal area (this is less common)
- bleeding between periods, heavier periods, and bleeding after sex (this is less common)
In men, symptoms of gonorrhea can include:
- an unusual discharge from the tip of the penis, which may be white, yellow, or green
- pain or burning sensation when urinating
- inflammation (swelling) of the foreskin
- pain or tenderness in the testicles (this is rare)
Source: NHS options
After swimming in the lake, the 11-year-old girl relaxed by soaking for an hour in a 20 cm deep thermal pool on the lake shore with her father and other tourists.
Meanwhile, her sister and mother were bathing in a similar but separate pool also by the lake.
Two days later, the boy began to feel a painful burning sensation.
They gave him an over-the-counter antifungal cream for a week while the family continued their vacation.
While this helped, it did not completely eradicate the symptoms, so the family took the 11-year-old to his GP when they returned to Austria two weeks later.
After inspecting the girl, the doctor took a swab that tested positive for gonorrhea.
Then all family members were tested for sexually transmitted infection (STI), but they came back negative.
Although sexual transmission was considered, the girl insisted that she had not had sexual intercourse.
Symptoms having started on vacation, and without “evidence” of sexual contact, it was concluded that she must have been infected by the pool water.
The girl, upon learning that she had an STI, was mortified and terrified that her peers would find out.
She was treated with an antibiotic injection in the hospital, followed by a course of antibiotic tablets.
While Professor Felicity Goodyear-Smith, author of the case report, said that while there were slight delays between diagnosis and treatment due to the Covid pandemic, the girl has made a full recovery.
In discussing the case, the authors noted that the pools at the edge of the ‘Mirror of Venus’ have a variety of factors that could cause the transmission of the bacteria that causes gonorrhea, Neisseria gonorrhoeae, possible.
They described the pools as “ nearly stagnant, ” close to body temperature, slightly acidic, and containing organic material – all factors that could help gonorrhea bacteria survive in their shallow waters.
Professor Goodyear-Smith said the public needs to know the potential dangers of sharing STI-contaminated water in these hot vacation spots.
“The public needs to understand that people who bathe in highly frequented shallow thermal pools are at risk of exposure to pathogens through inoculation by other bathers,” he said.
But he added that the providers of these facilities must also do more to ensure that people use them in a hygienic and safe way.
‘We suggest the provision of a shower and antibacterial soap near the hot springs. A sign should inform visitors about strict hygiene before entering the pools, ” he said.
The authors also note that girls are particularly susceptible to this very unusual type of gonorrhea infection.
The bacterium that causes gonorrhea infection, called Neisseria gonorrhoeae (pictorial representation in the photo) is commonly transmitted through sexual contact, but a new case suggests that it can also be transmitted by sharing water under certain conditions.
This is because the genitals of girls are less acidic than those of adult women and therefore more vulnerable to the gonorrhea bacteria, they explained.
Professor Goodyear-Smith said it was “almost certain” that the girl had contracted gonorrhea from the contaminated pool rather than from sexual contact.
But they emphasized that it was critical that the circumstances surrounding all gonorrhea infections in children be thoroughly investigated to identify any possible sexual abuse.
The authors also noted that, although rare, this was not the first recorded case of children contracting gonorrhea in non-sexual ways.
They cited cases in which children had contracted gonorrhea from a public toilet seat and from sharing towels with infected family members.
Historically, children had also contracted gonorrhea from common toilets in places like hospitals, the authors said.
Professor Anna Geretti, an infectious disease expert at King’s College London, told MailOnline that the case, while extreme, was not out of the question.
“It’s not completely outlandish,” he said.
“Reports made in the late 1800s and early 1900s speak of contracting this infection, especially in prepubertal girls.”
“Somehow we have lost the memory of this knowledge.” In the specific case of the 11-year-old child
However, he agreed with the authors that all cases of gonorrhea in children should be thoroughly investigated for possible abuse.
Professor Geretti explained that in this specific case an incredible combination of factors such as the perfect water temperature for gonorrhea and proximity to an infected stranger would have to be present.
This would make any chance of a repeat incident extremely low, he said.
“The gonorrhea bacteria grows very well between 25 and 39 degrees, but dies if it goes from 50 to 55,” he said.
“We know from laboratory experiments that bacteria can survive for a few hours when released in warm, humid conditions.”
Professor Geretti said that people should always shower with soap after using the shared thermal baths for hygiene reasons.