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

Abstract

SUMMARY Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of 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, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae , including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

Sexually transmitted infections: challenges ahead

“…153 The hypothesis is that, in modern times, AMR in gonococci has usually 551 developed first in the WHO Western Pacific Region (frequently Japan) followed by 552 international spread. 153,155,156 For many infectious diseases including gonorrhoea, overuse and settings with a high incidence of gonorrhoea and ineffective control measures.…”

“…153,155,156 For many infectious diseases including gonorrhoea, overuse and settings with a high incidence of gonorrhoea and ineffective control measures. 152,153,155,156,158 …”

Die deutsche Laborlandschaft zu Diagnostik und Antibiotikaresistenztestung bei Neisseria gonorrhoeae

“…In den letzten Jahren zeigte sich insbesondere in den USA und England, dass der NAT den kulturellen Nachweis aus der NG-Routinediagnostik aufgrund seiner hohen Sensitivität sowie einfacheren Durchführung verdrängt [9]. Im Rahmen einer NG-Diagnostik bietet momentan jedoch lediglich der kulturelle Nachweis die Möglichkeit für eine zusätzliche Antibiogrammerstellung [9,12,13]. Das European Centre of Disease Prevention and Control (ECDC) wies auch für Europa auf die zunehmende Verbreitung des NATs und den damit einhergehenden, zunehmenden Verlust der Möglichkeit für eine direkte Antibiotikaresistenztestung hin [12].…”

Antibiotic-resistant Neisseria gonorrhoeae spread faster with more treatment, not more sexual partners

“…Antibiotic-resistant Neisseria gonorrhoeae can evolve and spread rapidly [1]. Resistance is commonly observed against the antibiotic classes penicillin, tetracycline and fluoroquinolones [2,3,4].…”