The serious threat of multidrug-resistant and untreatable gonorrhoea: the pressing need for global action to control the spread of antimicrobial resistance, and mitigate the impact on sexual and reproductive health

Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future

“…Furthermore, the WHO has published a global action plan (13,14), and the U.S. CDC (11) and the European Centre for Disease Prevention and Control (ECDC) (12) have published regional response plans, to control and mitigate the spread of multidrugresistant N. gonorrhoeae. A key component of these action/response plans is to substantially enhance the quality-assured surveillance of gonococcal AMR and gonorrhea treatment failures (using recommended treatments), locally, nationally, and internationally.…”

“…However, internationally, there is now a high prevalence of N. gonorrhoeae strains with resistance to most antimicrobials previously and currently widely available for treatment (e.g., sulfonamides, penicillins, earlier cephalosporins, tetracyclines, macrolides, and fluoroquinolones). The recent occurrence of failures to treat gonorrhea with the extended-spectrum cephalosporins (ESCs) cefixime and ceftriaxone and the emergence of gonococcal strains exhibiting high-level clinical resistance to all ESCs (2)(3)(4)(5), combined with resistance to nearly all other available therapeutic antimicrobials, have caused great concern, as evidenced by publications in the medical literature (5)(6)(7)(8)(9) and the lay press (10) and by development of global, regional, and national action/response plans (11)(12)(13)(14). In most settings worldwide, ceftriaxone is the last remaining option for empirical first-line antimicrobial monotherapy.…”

“…The looming public health crisis of antimicrobial-resistant gonococci cannot be understated, as treatment regimens will most certainly become more expensive, and as treatment failures occur, medical costs will increase substantially as a result of severe complications that compromise the general and reproductive health of infected individuals (11)(12)(13)(14). Given the global nature and large burden of gonorrhea, the high-level and frequently uncontrolled usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, the global problem of gonococcal AMR will likely worsen in the foreseeable future, and the severe complications of gonorrhea will emerge as a silent epidemic.…”

What is the appropriate therapy for asymptomatic gonorrhoea in men who have sex with men?

“…As such, there is a risk of the new gonorrhoea infection acquiring these resistance mechanisms. This transfer of antibiotic resistance genes from indigenous microbes to newly arriving N. gonorrhoeae is thought to have been important in the genesis of gonococcal cephalosporin resistance 10 and in other examples of rapid acquisition of antibiotic resistance.…”

“…10 We still do not understand why gonococcal resistance to quinolones and cephalosporins first emerged in MSM. 12 One study that investigated explanatory factors found that a higher antibiotic usage in the prior 60 days to be a risk factor.…”