Emerging sex disease MG 'could become next superbug' – BBC News

Emerging sex disease MG ‘could become next superbug’ – BBC News

Emerging sex disease MG ‘could become next superbug’ By Michelle Roberts Health editor, BBC News online 11 July 2018 These are external links and will open in a new window Close share panel Image copyright Getty Images A little known sexually transmitted infection could become the next superbug unless people become more vigilant, experts are warning.
Mycoplasma genitalium (MG) often has no symptoms but can cause pelvic inflammatory disease, which can leave some women infertile.
MG can be missed – and if it is not treated correctly, it can develop resistance to antibiotics.
Its draft guidelines detail how best to spot and treat MG. What is MG?
Mycoplasma genitalium is a bacterium that can cause inflammation of the urethra in men, causing discharge from the penis and making it painful to urinate.
In women, it can cause inflammation of the reproductive organs (womb and fallopian tubes) too, causing pain and possibly a fever and some bleeding.
You can get it by having unprotected sex with someone who has it. Condoms can prevent this spread.
It was first identified in the UK in the 1980s and is thought to affect 1-2% of the general population.
MG does not always cause symptoms and will not always need treatment, but it can be missed or mistaken for a different sexually transmitted infection, such as Chlamydia. ‘World’s worst’ super-gonorrhoea man cured
The BASHH says this is concerning.
Tests for MG have recently been developed but are not available in all clinics yet although doctors can send samples to Public Health England’s laboratory to get a diagnostic result.
It can be treated with antibiotics – but the infection is developing resistance to some of these drugs. ‘I tested positive for MG’
John – not his real name – contacted the BBC to tell of his experience of having the infection.
“I was diagnosed with MG last year after meeting my new partner.
“We both sensibly got tested and declared clean at the start of the relationship but GUM [genitourinary medicine] clinics don’t test for MG, unless you have symptoms.
“So about a month into the relationship I developed the male symptoms – a sharp burning pain while urinating and a pus-like dishcharge from my urethra – but I had no idea what was wrong.
“After a few weeks I tested positive, while my partner was negative, which didn’t make sense. She then got tested again and was positive.
“We were put on antibiotics for two weeks but had no sexual contact for five, to make sure we were clean. After further tests we both tested negative but I still had some small amount of leakage which I was told would go away. It eventually cleared.
“Then out of the blue I got a UTI and symptoms were exactly like MG.
“I am now certain it has returned and I am awaiting further test results.
“The GUM clinic refused to retest my partner as she hasn’t shown any symptoms.
“I think clinics should test for MG as part of their sexual health screening process, as this would have been picked up at the start for me.” ‘Pack condoms’
Eradication rates of MG following treatment with one family of antibiotics, called macrolides, are decreasing globally. Macrolide resistance in the UK is estimated at about 40%, say the guidelines.
One particular macrolide antibiotic, azithromycin, still works in most cases however.
Dr Peter Greenhouse, a sexual consultant in Bristol and BASHH member, urged people to take precautions.
“It’s about time the public learned about Mycoplasma genitalium ,” he said.
“It’s yet another good reason to pack the condoms for the summer holidays – and actually use them.” ‘Out of control’
Paddy Horner, who co-wrote the guidelines, said: “These new guidelines have been developed, because we can’t afford to continue with the approach we have followed for the past 15 years as this will undoubtedly lead to a public health emergency with the emergence of MG as a superbug.
“Our guidelines recommend that patients with symptoms are correctly diagnosed using an accurate MG test, treated correctly then followed up to make sure they are cured.
“Resources are urgently needed to ensure that diagnostic and antimicrobial resistance testing is available for women with the condition who are at high risk of infertility. MG – what to look out for
“We are asking the government directly to make this funding available to prevent a public health emergency waiting to happen and which is already spiralling out of control.”
Public Health England says testing is available to diagnose MG and any signs of drug resistance, if necessary.
Dr Helen Fifer, consultant microbiologist at Public Health England, welcomed the guidelines, adding: “If you have symptoms of an STI, we recommend you get tested at your local sexual health clinic.
“Everyone can protect themselves from STIs by consistently and correctly using condoms with new and casual partners.” Related Topics

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Cave rescue: Key questions answered – BBC News

Image copyright Reuters Image caption Certain details about the rescue are only now coming to light After 17 days underground, all the Thai boys and their football coach have safely escaped from the Tham Luang cave complex.
A team of Thai and international divers mounted a dangerous and complicated rescue to bring the boys out, and details of the bid are still emerging now.
BBC correspondent Jonathan Head has answered some of the core questions about the boys, the rescue attempt, and what happens next. Why did the kids go so deep into the cave?
We will not know that until we hear from them and their assistant coach, Ekkapol “Ake” Chantawong.
On that Saturday they were scheduled to play a match, which was cancelled, according to head coach Nopparat Kanthawong. He scheduled a training session instead.
The boys were keen cyclists so on the Facebook chat group through which they communicated with the parents, coach Ake suggested they cycle to the football field.
There was no suggestion there that they would go on to the caves. Image copyright Facebook/ekatol Image caption A Facebook photo shows the coach with some of the young footballers
Saturday was the 16th birthday of Pheeraphat ‘Night’ Sompiengjai, and a local shop said the boys spent more than 700 baht (US$22) on food to celebrate, a large sum in this area.
Coach Nop describes Ake as being very kind-hearted and devoted to the boys. He thinks the boys persuaded him to go with them into the caves. The caves are well-known in the area and had been explored by the boys before.
The best guess is they went quite deep, which is easy when they are dry, got caught by rising flood water, and were forced to go even deeper. What kind of communication have the children had with their parents and why are they not being allowed to see them?
The official explanation is they are weak from their ordeal and potentially vulnerable to infection.
These are now very precious lives in Thailand. A massive effort has been made to get them out alive. The Thai authorities are taking no chances. Media playback is unsupported on your device Media caption The boys give peace signs as they recover in hospital
Perhaps they also wanted to avoid the excitement of seeing their parents again. Thais are generally less physical than westerners. Hugging is unusual.
And the parents are from poor, marginal communities, used to being told what to do by officials, and probably grateful for the lengths the government went to in rescuing them. They would not protest.
They were allowed to see them through windows, and are gradually being allowed in, wearing gloves and facemasks, to stand in the same room. Will coach Ake face any disciplinary proceedings?
At this stage that seems unlikely. The parents say they have forgiven him, and they are grateful for the efforts he is reported to have made to keep their spirits up in the caves, in particular through meditation, which he learned during 12 years as a monk. How did the boys survive underground?
Coach Nop said Ake may be asked to go back to being a monk for a while, something Thais typically do as a kind of penance, or to replenish or cleanse themselves spiritually.
Such a move would make a lot of sense to Thais, and he would likely be allowed to resume life as normal after that.
Also Thailand typically does not have a ‘blame culture’, where a culprit must be found for any misadventure. There is a more fatalistic acceptance of things going wrong, less public clamour for accountability. How did they survive so long with so little food, and lose so little weight?
The boys were in the caves nine days before they were found. They may have had a little food from what they bought to celebrate Night’s birthday. They are passionate football players, very fit, and with the training they have had a tight-knit team.
This would have helped them ration their food carefully and support each other, perhaps with songs. Media playback is unsupported on your device Media caption Child psychiatrist: “It will be a challenge for these children to go back to normal life”
Coach Ake taught them to meditate, say Thai navy divers, and gave them more food than he ate. He also told them to drink water dripping from the rocks, rather than polluted ground water.
During their last six to eight days they were being fed, initially high-protein gels, but later more normal food, which might have allowed them to start putting on a little weight before coming out. Were they in the dark the whole time?
Most of the time. They went in with cheap torches, which would not have lasted long. It is likely they were in the dark for most of the first nine days of their ordeal.
Once they were found a Thai army doctor and at least three divers stayed with them, equipped with good torches. Even so they were mostly in the dark, and had to wear sunglasses when they were first brought out. Image copyright Thai Navy SEALs/Getty Images Image caption Rescuers brought them food, light and letters from their parents to help them cope Were they sedated in any way?
The Thai authorities are being very coy about this.
Prime Minister Prayuth Chan-ocha said they had been lightly sedated. But the BBC has spoken to a number of people involved in the operation who say the boys were heavily sedated, and only semi-conscious.
The logic for this would be the fear their rescuers had that they would panic when wearing diving equipment for the first time in darkness and swirling cave water, endangering the lives of all of them.
The two British cave divers who led the rescue effort, John Volanthen and Richard Stanton, are believed to have asked for Australian Richard Harris, a cave diver and anaesthetician , to assist in preparing the boys. The heroes who saved the Wild Boars
How they carried semi-conscious or very drowsy boys through the technically challenging early stages of the journey out, with a lot of diving in narrow passages, we do not know.
At times they may have been strapped to a diver’s body. Later they were strapped on to a stretcher and suspended from a rope pulley system attached to the cave roof.
The entire operation was complex, innovative and very bold. Nothing like it has been attempted before. Some of those involved described the tasks undertaken by the core divers, who carried the boys out, as superhuman. Who has paid for this operation?
The Thai government, for most of it.
It is likely that the contribution by other countries, like the 30 US air force personnel who went to help, would have been funded by their own governments as a gesture of good will.
Many Thai businesses supported with transport and food. Thai Airways and Bangkok Airways offered free flights to some of the foreign divers coming in. Media playback is unsupported on your device Media caption Thailand cave rescue: Meet the volunteer helpers Could the Thais have done this on their own?
No, and few countries could. Cave diving is a very specialised skill, and expert cave rescuers are even rarer.
Thailand was fortunate that an experienced caver Vern Unsworth has explored the Tham Luang cave complex extensively, and lives nearby.
He was on the scene the day after the boys disappeared, and suggested that the Thai government needed to invite expert divers from other countries to help. As it happened – Thai cave rescue
The Thai navy divers who went down initially struggled, because both their experience and equipment were for sea diving, which is very different. They were driven out of the caves by rapidly rising flood water, and finding the boys seemed a hopeless cause.
Once foreign divers arrived, from many different countries, the Thai authorities allowed them to devise first the search, and then the enormously complex rescue. It was a huge logistical operation involving hundreds of people, building guide rope and pulley systems, putting in power and communication cables.
It is to Thailand’s credit that it was organised so well, and there was no attempt to diminish the foreign contribution.
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The staggering rise of India’s super-rich | News

O n 3 May, at around 4.45pm, a short, trim Indian man walked quickly down London’s Old Compton Street, his head bowed as if trying not to be seen. From his seat by the window of a nearby noodle bar, Anuvab Pal recognised him instantly. “He is tiny, and his face had been all over every newspaper in India ,” Pal recalled. “I knew it was him.”
Few in Britain would have given the passing figure a second look. And that, in a way, was the point. The man pacing through Soho on that Wednesday night was Nirav Modi: Indian jeweller, billionaire and international fugitive.
In February, Modi had fled his home country after an alleged $1.8bn fraud case in which the tycoon was accused of abusing a system that allowed his business to obtain cash advances illegally from one of India’s largest banks. Since then, his whereabouts had been a mystery. Indian newspapers speculated that he might be holed up in Hong Kong or New York. Indian courts issued warrants for his arrest, and the police tried, ineffectually, to track him down.
It was only by chance that Pal spotted him. A standup comic normally based in Mumbai, he happened to be in London for a run of gigs. “My ritual was to go to the same noodle bar, have a meal, and then head to the theatre,” Pal said. “I always sat by the window. And then suddenly Modi walks past. He was unshaven, and had those Apple earphones, the wireless ones. He looked like he was in a hurry.”
It was another month before the press finally caught up with Modi, as reports of his whereabouts emerged in June, along with the suggestion that he was planning to claim political asylum in the UK. (Modi denies wrongdoing, and did not respond to requests for comment.) In the process, Modi also gained entry into one of London’s more notorious fraternities: the small club of Indian billionaires who seem to end up in the British capital following scandals back at home.
The most prominent among these émigré moguls is India’s “King of Good Times”, Vijay Mallya, the one-time aviation magnate and brewer, who transformed Kingfisher beer into a global brand. A few years ago, Mallya was one of India’s most celebrated industrialists, famous for his mullet haircut and flamboyant lifestyle. But in early 2016, Indian authorities filed charges relating to the collapse of his Kingfisher airline, which went bust in spectacular fashion in 2012, leaving behind mountainous debts and irate, unpaid staff. And so, facing allegations of financial irregularities and of refusing to repay outstanding loans, Mallya quietly boarded a plane for Britain, too.
Like Modi, Mallya denies wrongdoing. Last month he released a long statement accusing India’s government of conducting a witch-hunt against him. And to the extent that this claim has some merit, it is because Indian prime minister Narendra Modi (no relation to Nirav Modi) has of late been under great pressure to bring supposedly errant tycoons such as Mallya to book.
Men like Mallya and Modi were members of India’s expanding billionaire class, of whom there are now 119 members, according to Forbes magazine. Last year their collective worth amounted to $440bn – more than in any other country, bar the US and China. By contrast, the average person in India earns barely $1,700 a year. Given its early stage of economic development, India’s new hyper-wealthy elite have accumulated more money, more quickly, than their plutocratic peers in almost any country in history.
Facebook Twitter Pinterest A cardboard cut-out of billionaire jeweller Nirav Modi at a protest against him in New Delhi in February. Photograph: Chandan Khanna/AFP/Getty Images
Narendra Modi won an overwhelming election victory in 2014, having promised to put a stop to the spate of corruption scandals that had dogged India for much of the previous decade. Many involved prominent industrialists – some directly accused of corruption, while others had simply mismanaged their finances and miraculously managed to escape the consequences. Voters turned to Narendra Modi, the self-described son of a poor tea-seller, hoping he would deliver a new era of clean governance and rapid growth, ridding India of a growing reputation for crony capitalism.
Narendra Modi pledged to end a situation in which the country’s ultra-wealthy – sometimes called “Bollygarchs” – appeared to live by one set of rules, while India’s 1.3 billion people operated by another. Yet as they continue to hide out in cities like London, men like Mallya and Nirav Modi have come to be seen as representing the failure of that pledge; the Indian authorities “have a long road ahead”, as one headline put it in the Hindustan Times last year, referring to a “long and arduous” future extradition process in Mallya’s case.
And as Narendra Modi gears up for a tough re-election battle next year, he is fighting the perception that India is unable to bring such men to heel, and that it has been powerless to respond to the rise of this new moneyed elite and the scandals that have come with them. “This ongoing battle to get India’s big tycoons to play by the rules is one of the biggest challenges we face,” says Reuben Abraham, chief executive of the IDFC Institute, a Mumbai-based thinktank. “Getting it right is central to India’s economic and political future.”
I ndia has long been a stratified society, marked by divisions of caste, race and religion. Prior to the country winning independence in 1947, its people were subjugated by imperial British administrators and myriad maharajas, and the feudal regional monarchies over which they presided. Even afterwards, India remained a grimly poor country, as its socialist leadership fashioned a notably inefficient state-planned economic model, closed off almost entirely from global trade. Over time, India grew more equal, if only in the limited sense that its elite remained poor by the standards of the industrialised west.
But no longer: the last three decades have seen an extraordinary explosion of wealth at the top of Indian society. In the mid-1990s, just two Indians featured in the annual Forbes billionaire list, racking up around $3bn between them. But against a backdrop of the gradual economic re-opening that began in 1991, this has quickly changed. By 2016, India had 84 entries on the Forbes billionaire list. Its economy was then worth around $2.3tn, according to the World Bank. China reached that level of GDP in 2006 , but with just 10 billionaires to show for it. At the same stage of development, India had created eight times as many.
In part, this wealth is to be welcomed. This year India will be the world’s fastest-growing major economy. During the last two decades, it has grown more quickly than at any point its history, a record of economic expansion that helped to lift hundreds of millions out of poverty.
Nonetheless, India remains a poor country: in 2016, to be counted among its richest 1% required assets of just $32,892, according to research from Credit Suisse. Meanwhile, the top 10% of earners now take around 55% of all national income – the highest rate for any large country in the world.
Put another way, India has created a model of development in which the proceeds of growth flow unusually quickly to the very top. Yet perhaps because Indian society has long been deeply stratified, this dramatic increase in inequality has not received as much global attention as it deserves. For nearly a century prior to independence, India was governed by the British Raj – a term taken from the Sanskrit rājya , meaning “rule”. For half a century after 1947, a system dominated by pernickety industrial rules emerged, often known as the Licence-Permit-Quota Raj, or Licence Raj for short. Now a system has grown in their place once again: the billionaire Raj.
The rise of India’s super-rich – the first and most obvious manifestation of the billionaire Raj – was propelled by domestic economic reforms. Starting slowly in the 1980s, and then more dramatically against the backdrop of a wrenching financial crisis in 1991, India dismantled the dusty stockade of rules and tariffs that made up the Licence Raj. Companies that had been cosseted under the old regime were cleared out via a mix of deregulation, foreign investment and heightened competition. In sector after sector, from airlines and banks to steel and telecoms, the ranks of India’s tycoons began to swell.
Nothing symbolises the power of this billionaire class more starkly than Antilia, the residential skyscraper built in Mumbai by Mukesh Ambani, India’s richest man. Rising 173 metres above India’s financial capital, the steel-and-glass tower is rumoured to have cost more than $1bn to build, looming over a city in which half the population still live in slums.
Facebook Twitter Pinterest The Antilia building, at right of photograph, in Mumbai. Photograph: Alamy
Ambani owns Reliance Industries, an empire with interests stretching from petrochemicals to telecoms. (His father, Dhirubhai, from whom he inherited his company, was one of the main beneficiaries of the economic reforms of the 1980s.) At Antilia, Ambani entertains guests in a grand, chandeliered ballroom that takes up most of building’s ground floor. There are six storeys of parking for the family’s car collection, while the tower’s higher levels feature opulent apartments and hanging gardens. Further down, in sub-basement 2, the Ambanis keep a recreational floor, which includes an indoor football pitch. Antilia became an instant landmark upon its completion in 2010. The city had long been a place of stark divisions, yet the Ambani’s home almost seemed to magnify this segregation. (A spokesman for Reliance did not respond to a request for comment.)
The emergence of the Indian super-rich was bound up in larger global story. The early 2000s were the heyday of the so-called “great moderation”, when world interest rates stayed low and industrialised nations grew handsomely. This was also when the fortunes of India’s new tycoons began to change. Pumped up by foreign money, domestic bank loans and a surging sense of self-belief, industrialists went on a spending spree. Ambani dumped billions into oil refineries and petrochemical plants. Vijay Mallya spent heavily on new fleets of Airbus jets. Nirav Modi began building a global chain of jewellery stores. Stock markets boomed. From 2004 to 2014, India enjoyed the fastest expansion in its history, averaging growth of more than 8% a year.
The boom years brought benefits, most obviously by reintegrating India into the world economy. Yet this whirlwind growth also proved economically disruptive, socially bruising and environmentally destructive, leaving behind what the writer Rana Dasgupta describes as a sense of national trauma. India’s new wealth has been shared remarkably unevenly, too. Its richest 1% earned about 7% of national income in 1980; that figure rocketed to 22% by 2014, according to the World Inequality Report. Over the same period, the share held by the bottom 50% plunged from 23% to just 15%.
Unsurprisingly, some feel resentful. “You walk around the streets of this city, and the rage at Antilia has to be heard to be believed,” Meera Sanyal, a former international banker turned local anti-corruption campaigner, told me in 2014. Six years before that, in 2008, as the scale of India’s billionaire fortunes were becoming clear, Raghuram Rajan – an economist who would later become the head of India’s central bank – asked an even more pointed question about his country’s tycoon class: “If Russia is an oligarchy, how long can we resist calling India one?”

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Czech communists return to government as power brokers | World news

Czech communists have savoured their first taste of power in nearly 30 years after their backing in a parliamentary confidence vote paved the way for a government headed by Andrej Babiš, a scandal-tainted billionaire tycoon, amid vehement protests against their return to the political mainstream.
The 15 MPs of the Communist party of Bohemia and Moravia (KSCM) provided the votes needed to allow a pact formed between Babiš’ Action of Dissatisfied Citizens (ANO) movement and the Social Democrats (ČSSD) to survive its first test, ending nearly nine months of political stalemate that saw the Czech Republic governed by temporary administrations. The vote – shortly after 1am local time on Thursday – followed a marathon debate lasting more than 12 hours in which opposition MPs voiced fierce opposition to the idea a government reliant on Communist support and questioned Babiš’ fitness to govern in the face of criminal allegations against him. Protests took place outside the parliament building and one conservative opposition party, Top 09, staged a symbolic walkout. In the end, 105 MPs in the 200-member chamber voted for the new government. One leading Social Democrat, Milan Chovanec, a former interior minister, declined to give his backing, citing his conscience.
The show of support came after the communists signed a deal with ANO agreeing to “tolerate” the new government – overriding ideological misgivings about Babiš’ wealthy status in exchange for having some policy pledges adopted and being given influential roles in public utilities. Although the party will formally remain outside the coalition, the agreement marks a return to influence and responsibility for the first time since the 1989 Velvet Revolution that ended the communists’ 41-year rule of the former Czechoslovakia. MPs from a conservative opposition party, Top 09, walked out in protest before Wednesday’s vote, while members of the right-wing Christian Democrat party unfurled a banner featuring Soviet red star in a vivid sign of enduring anti-communist feeling in the country. Demonstrations have been staged in Prague and other cities against the rehabilitation of a party still remembered bitterly for its totalitarian methods and ruthless clampdown on dissent during the cold war. “For many people who support right-of-centre parties, this is a big moral and psychological problem, because they see it in symbolic terms and feel it’s not right,” said Jiří Pehe, director of New York University’s campus in Prague and a Czech political analyst. Babiš, who was sworn in as prime minister for a second time last month, disregarded such qualms after more moderate parties declined to serve under him because he faces criminal fraud charges over allegations that he falsely obtained nearly €2m of EU funds for his giant agrochemical business a decade ago. He denies the charges, which he has called politically motivated. Babiš, the Czech Republic’s second-richest man, has also been tarred with a communist past after being named as a former secret police agent when he worked for a Czechoslovak trading company, a charge he disputes. He won communist support for his coalition by agreeing to tax church property that had been restored to it after being seized while the party was in power. However, he has resisted their demands to dilute the Czech Republic’s commitments to Nato, knocking back its demand to cut troop deployments to the Baltic republics and Afghanistan. Babiš’ previous caretaker administration also angered the communists – considered close to the government of Russia’s president, Vladimir Putin – by expelling three of Moscow’s diplomats in solidarity with Britain over the poisoning of the former Russian spy Sergei Skripal and his daughter Yulia in Salisbury. “Babiš has done all this because he feels he doesn’t have democratic legitimacy and is suspected of not being a true liberal democrat,” said Pehe. “He wants to look pro-western, pro-Nato and pro-EU – and he’s made it clear to the communists that he’s not going to compromise on that.” But his government is certain to maintain a hardline anti-migrant stance after Miloš Zeman, the populist Czech president, refused to accept the Social Democrats’ nominee for foreign minister, the MEP Miroslav Poche, on the grounds that he was too liberal on immigration.

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