Neisseria gonorrhoeae is the agent of gonorrhea, a sexually transmitted infection with an estimate from The World Health Organization of 78 million new cases in people aged 15–49 worldwide during 2012. If left untreated, complications may include pelvic inflammatory disease and infertility. Antimicrobial treatment is usually effective; however, resistance has emerged successively through various molecular mechanisms for all the regularly used therapeutic agents throughout decades. Detection of antimicrobial susceptibility is currently the most critical aspect for N. gonorrhoeae surveillance, however poorly structured health systems pose difficulties. In this review, we compiled data from worldwide reports regarding epidemiology and antimicrobial resistance in N. gonorrhoeae, and highlight the relevance of the implementation of surveillance networks to establish policies for gonorrhea treatment.

The main objective of this study was to assess the frequency and possible sources of colonization and infection by Acinetobacter in the intensive care unit (ICU) of a university hospital in Rio de Janeiro, Brazil, and characterize the isolates for relatedness to internationally and locally disseminated lineages. Patients consecutively admitted to the ICU from April 2007 to April 2008 were screened for colonization and infection. Species were identified by rpoB sequencing. The presence of acquired and intrinsic carbapenemase genes was assessed by polymerase chain reaction (PCR). Strains were typed by random amplification of polymorphic DNA (RAPD)-PCR, pulsed-field gel electrophoresis, and multilocus sequence typing (MLST) using the schemes hosted at the University of Oxford (UO) and Institut Pasteur (IP). Of 234 patients, 98 (42%) had at least one specimen positive for the Acinetobacter isolate, and 24 (10%) had infection. A total of 22 (92%) infections were caused by Acinetobacter baumannii and one each (4%) by Acinetobacter nosocomialis and Acinetobacter berezinae. A. baumannii isolates from 60 patients belonged to RAPD types that corresponded to MLST clonal complexes (CCs) 109/1 (UO/IP scheme, known as International Clone I), CC 110/110 (UO/IP), CC 113/79 (UO/IP), and CC 104/15 (UO/IP). Most CCs were carbapenem resistant and carried the bla(OXA-23)-like gene. Strains were introduced by patients transferred from other wards of the same hospital (11 patients, 18%) or acquired from cross-transmission within the ICU (49 patients, 82%). A. nosocomialis lineage sequence type 260 colonized 10% of the whole study population. A. baumannii have become established in this hospital as a part of a global epidemic of successful clones. Once introduced into the hospital, such clones have become entrenched among patients in the ICU.

Resistance in Neisseria gonorrhoeae is a global public health challenge. However, little is known about N. gonorrhoeae isolates from Brazil. In this study, we characterized 116 N. gonorrhoeae isolates obtained in Rio de Janeiro between 2006 and 2015 according to antimicrobial susceptibility profiles, resistance mechanisms, and clonal diversity. We determined antimicrobial minimal inhibitory concentrations by agar dilution, and whole genome sequencing was conducted to investigate alleles related to resistance, determine multilocus sequence typing profiles, and group isolates based on core genome single nucleotide polymorphisms. Resistance to penicillin, tetracycline, ciprofloxacin, and azithromycin was observed since 2006. Resistance to penicillin was mediated by β-lactamase plasmids and chromosomal mutations in ponA and porB genes, and tetracycline resistance was mediated by TetM plasmids, and porB and rspJ mutations. Ciprofloxacin resistant isolates presented cumulative point mutations in the quinolone resistance-determining region (QRDR) of gyrA and parC. Alterations in rrl genes encoding 23S rRNA, mtrR, and the mtrR promoter region were responsible for resistance to azithromycin. Phylogenetic analysis identified seven main clades, which included isolates with similar resistance profiles that mainly belonged to a limited number of sequence types that occurred during different years. Our results demonstrated high penicillin, tetracycline, and ciprofloxacin resistance rates associated with the persistence of successful resistant gonococcal lineages, and the polyclonal emergence of azithromycin resistance. Moreover, we reinforce the importance of surveillance to monitor the evolution of this scenario and to allow the early detection of possible changes to azithromycin and ceftriaxone as effective treatment options in the city.

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Neisseria gonorrhoeae is rapidly developing antimicrobial resistance. There is an urgent need for an effective gonococcal vaccine. In this study we examined epidemiological and clinical factors associated with gonorrhea in a cohort of women exposed to men with gonococcal urethritis attending the National Center for STD Control clinic in Nanjing, China, to understand the natural history and the risk factors for gonorrhea in this vulnerable population. This analysis will help identify the best target populations for vaccination, which is essential information for the development of vaccine strategies. We observed that 75% of the women in our cohort yielded a N. gonorrhoeae positive culture (infected women) and reported multiple sexual exposures to their infected partner. Infected women were younger than exposed but uninfected women. Contrary to the general belief that gonorrhea is asymptomatic in most women, 68% of the infected women acknowledged symptoms during their STD clinic visit, and overt inflammatory responses were detected upon medical examination in 88% of subjects. Other sexually transmitted infections were detected in 85% of subjects. This study confirmed that N. gonorrhoeae infections are underdiagnosed in women and, consequentially, untreated. Thus, our analysis reinforces the need to establish strategies for gonococcal prevention through the determination of the target population for a gonococcal vaccine.