The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting

Abstract

From a once easily treatable infection, gonorrhoea has evolved into a challenging disease, which in future may become untreatable in certain circumstances. International spread of extensively drug-resistant gonococci would have severe public health implications. It seems clear that under the current treatment pressure from extended-spectrum cephalosporins, and owing to Neisseria gonorrhoeae's remarkable evolutionary adaptability, further rise of ceftriaxone-resistant strains around the world is inevitable. Simply increasing the doses of extended-spectrum cephalosporins will likely prove ineffective in the long run, and has been a lesson learnt for all single-agent therapies used for gonorrhoea to date. We recommend that dual therapy, especially those consisting of extended-spectrum cephalosporins and azithromycin, be adopted more widely and complemented by strengthening of antimicrobial resistance surveillance. Unless there is urgent action at international and local levels to combat the problem of N. gonorrhoeae antimicrobial resistance, we are in for gloomy times ahead in terms of gonorrhoea disease and control.

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

“…The current gold standard method to detect ESC ds is by isolation and phenotypic susceptibility testing, with strain typing performed on cultured isolates. Molecular characterization can be performed on isolates by sequencing of genes that exhibit single nucleotide polymorphisms (SNPs) correlated with decreased susceptibility or resistance to antibiotics (10,19) and genetic determinants for rapid strain typing. Due to the higher sensitivity offered by molecular methods, nucleic acid-based testing is now considered the gold standard for detection of N. gonorrhoeae (20).…”

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

“…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.…”

Neisseria gonorrhoeae Sequence Typing for Antimicrobial Resistance, a Novel Antimicrobial Resistance Multilocus Typing Scheme for Tracking Global Dissemination of N. gonorrhoeae Strains

“…Agreement on the nomenclature of antimicrobial resistance (AMR) determinants through an internationally available, curated, user-friendly database containing sequence information and appropriate microbiological, genetic, clinical, and epidemiological data is of the utmost importance (14)(15)(16).…”