On September 17th, 2021, an article entitled “Gonococcus infection probably acquired from bathing in a natural thermal pool: a case report” by researchers Felicity Goodyear-Smith and Robert Schabetsberger, was published in the Journal of Medical Case Reports. The findings of this report were also published in the online versions of the Daily Mail, The New York Post and Fox News.
The case report concerns an 11 year old Austrian girl, on holiday with her parents and younger sister on the island of Pantelleria, Italy, in August 2020, who allegedly contracted Neisseria gonorrhoeae, (commonly known as gonorrhea, a sexually transmitted infection) after soaking in the Specchio di Venere volcanic hot springs which are a major tourist attraction on the island.
Pantelleria is a small Italian island situated off the southern coast of Sicily, famous for its beautiful scenery, friendly residents, delicious cuisine and its hot volcanic springs, which are said to provide numerous health benefits. It has a population of only 7,759 but during the Summer months, hosts tourists from all over the world.
The case report and subsequent articles in the Daily Mail, The New York Post and Fox news make for alarming reading and are enough to deter anybody from ever taking a dip in the warm volcanic springs in Pantelleria. After all, who would want to risk contracting gonorrhea and the resulting awkward questions or life changing ramifications that a sexually transmitted infection would bring?
“Many academics in the field of sexual health, including the British National Health Service’s webpage, believe that transmission of gonorrhea is always a result of direct sexual contact.”
One of the authors of the case report is Professor Felicity Goodyear-Smith, an MD, who works in New Zealand for the University of Auckland in the faculty of medicine. A simple internet search shows extremely divisive opinions regarding her work and reputation within the international medical community. She is a vocal detractor of what she once described as “the sexual abuse industry” and the founder of COSA (Casualties of Sexual Allegations), a now defunct New Zealand organisation which offered support for those involved in “false sexual abuse allegations.”
Back to the case of the 11 year old Austrian girl, diagnosed with gonorrhea, allegedly contracted from the volcanic hot springs in Pantelleria, Italy. According to the case report, the girl developed vulvovaginal burning and discharge two days later, severe enough for her to find swimming in the sea too uncomfortable.
She was not seen by a gynecologist or indeed any type of medical doctor in Pantelleria but the family did obtain an over the counter antifungal cream which partially resolved her symptoms. Over two weeks later, when home in Austria, the girl was seen by her pediatrician. She showed no signs of sepsis and had a normal temperature and pulse. A vaginal swab was taken and returned positive for Neisseria gonorrhoeae.
Both the girl’s mother and father and her younger sister were tested for gonorrhea resulting in negative results. The girl responded well to treatment with antibiotics. The 11 year old child denied any sexual activity had taken place and the family state that there was no opportunity nor evidence for sexual transmission. However, it is not uncommon for children to deny sexual abuse due to shame, embarrassment or because of threats from their abuser.
“Both the girl’s mother and father and her younger sister were tested for gonorrhea resulting in negative results.”
The case report mentions the girl’s fear that classmates at her new high school would hear about the infection. If this infection was, as Goodyear-Smith and Robert Schabetsberger claim, caused by soaking in the volcanic pool in Pantelleria, the girl’s fear seems strange and potentially a red flag warranting further investigation.
It is not made clear how Professor Goodyear-Smith became aware of the case. After all, she lives and works in New Zealand and the family of the girl lives in Austria. An online search, however, does lead to her academic work describing non sexual transmission of gonorrhea.
Goodyear-Smith and Schabetsberger make recommendations in the case report to avoid contracting Neisseria gonorrhoea and other potential pathogens at the Specchio di Venere hot springs in Pantelleria which include the installation of a shower and antibacterial soap near the springs. They also recommend a sign making visitors aware of strict hygiene before entering the pools, none of which are a recognized mode of avoiding the transmission of gonorrhea.
The only cure for gonorrhea is a course of antibiotics and many academics in the field of sexual health, including the British National Health Service’s webpage, believe that transmission of gonorrhea is always a result of direct sexual contact. Gonorrhea in Italy, just as in New Zealand and Austria, is a notifiable disease which means every single case must be reported to the local health authorities.
I emailed Professor Goodyear-Smith on November 17th, shortly after the articles regarding the 11 year old girl with gonorrhea appeared in the press, asking her whether she requested water samples be taken from the Specchio di Venere in Pantelleria for analysis, specifically for gonococcus testing to support the claims of her case report. I also asked her to clarify whether she had notified the island of the potential dangers, particularly to prepubescent girls, of soaking in the volcanic springs.
“In her email to me, Goodyear-Smith states that the girl was simply in the wrong place at the wrong time and such an event may seldom, if ever, happen again.”
She sent a prompt reply stating that she did not have the resources to test the water. She also stated that some attempts were made to discuss the issue with local authorities but there was no response. I contacted the Mayor of Pantelleria, Vincenzo Campo, who stated that there was no record of any communication regarding the findings of Goodyear-Smith and Robert Schabetsberger, the co-author of the case report. Incidentally, the email address of the Mayor of Pantelleria is very easy to find online but the case report was not sent to him by the authors.
Despite the sensational media reports, this is a case study which is far from definitive. In her email to me, Goodyear-Smith states that the girl was simply in the wrong place at the wrong time and such an event may seldom, if ever, happen again. She also states that testing of the water would be unlikely to find gonorrhea… as it would have been slowly flushed away and claims that the biochemical composition of the water allowed gonococci, the bacteria which causes gonorrhea, to survive after an infected visitor shared the pool with the young girl. In other words, a freak occurrence.
Is this indeed a freak occurrence or is the 11 year old girl a victim of sexual abuse? Due to the delayed vaginal swab and, as per Goodyear-Smith and Schabetsberger, the futility of testing the water at the hot springs in Pantelleria, together with no formal reporting of a case of gonorrhea to the Italian health authority, the cause of an 11 year old girl contracting gonorrhea remains open to debate.
The authors of the original case study themselves admit, “The case weakness is that, inevitably, it is impossible to prove that the pool was the definitive source of infection.” That’s a lot of dramatic headlines, bordering on hysteria, by the media for an unproven theory.
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