The Gonococcus fights back: is this time a knock out?

Abstract

Since the introduction of antibiotics in the 1930s, Neisseria gonorrhoeae has exhibited a remarkable ability to acquire novel genetic resistance determinants. Initially, sulphonamides were replaced by penicillin, while tetracyclines were prescribed for penicillin-allergic patients. With the advent of penicillinase-producing gonococci, spectinomycin was only briefly useful as alternative treatment and plasmid-mediated tetracycline resistance spread rapidly from the mid-1980s onwards. The fluoroquinolones followed but chromosomally mediated resistance appeared after only a decade of use. Seventy years on, we now face a global public health challenge of immense significance--the emergence of resistance to cephalosporins. With lack of investment in the search for new anti-gonococcal antimicrobial agents or vaccine research, the global spread of multiresistant gonococci can be seen. The impact of untreatable gonorrhoea on HIV transmission could be enormous in high-prevalence countries. This threat comes at a time when many national STI control programmes are weak. To delay the emergence of extensively drug-resistant gonorrhoea, public health systems require strengthening and novel strategies need implementing to enhance the therapeutic lifespan of the few antimicrobial agents that we have left.

Utility of Specimens Positive for Neisseria gonorrhoeae by the Aptima Combo 2 Assay for Assessment of Strain Diversity and Antibiotic Resistance

“…Over the years, gonococci have developed resistance to multiple classes of antibiotics, including penicillins, tetracyclines, macrolides, and quinolones (2). Of recent concern is a steady increase in the MICs to extended-spectrum cephalosporins, including cefixime and ceftriaxone, in several countries including Canada, with reported levels at 0.12 g/ml, one doubling dilution away from the Clinical and Laboratory Standards Institute (CLSI) limit of 0.25 g/ml for susceptibility (3)(4)(5)(6)(7); CLSI standard M100-S23, January 2013).…”

Molecular Analyses of TEM Genes and Their Corresponding Penicillinase-Producing Neisseria gonorrhoeae Isolates in Bangkok, Thailand

“…During recent decades, N. gonorrhoeae has rapidly developed resistance to most classes of antimicrobials used for treatment of gonorrhea (4,6,17,18,20). Penicillinase-producing N. gonorrhoeae (PPNG), with plasmid-mediated high-level resistance to penicillin, was first reported in 1976 (1,14) and has since been disseminated worldwide (2).…”

Assessment of antibacterial activity of crude leaf and root extracts of <i>Cassia alata</i> against <i>Neisseria gonorrhea</i>.

“…In Uganda, diagnosis of gonorrhea is usually done clinically, based on patients' symptoms and since gonorrhea is usually asymptomatic especially in women, most cases go undetected. There is an increasing rise in resistance to drugs used for treatment of gonococcal infections with most patients left poorly treated [5][6][7][8][9][10] . Poorly treated or undetected gonorrhea can cause complications like pelvic inflammatory disease in women; which can lead to ectopic pregnancy and infertility; and epididymitis and prostatitis in men 4,9,11 .…”

“…There is an increasing rise in resistance to drugs used for treatment of gonococcal infections with most patients left poorly treated [5][6][7][8][9][10] . Poorly treated or undetected gonorrhea can cause complications like pelvic inflammatory disease in women; which can lead to ectopic pregnancy and infertility; and epididymitis and prostatitis in men 4,9,11 . These complications need prolonged treatment that becomes very expensive and often unattainable by resource limited countries including Uganda.…”