Antimicrobial Resistance in Neisseria gonorrhoeae: A New Challenge

Abstract

The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern also considering the occurrence of untreatable gonorrhoea infections. The pathogen has developed resistance to all drugs previously (penicillin, tetracycline and ciprofloxacin) and currently recommended (azithromycin and extended-spectrum cephalosporins, ESCs, such as cefixime and ceftriaxone) for therapy through chromosomal and/or plasmid-mediated mechanisms. Since there is no vaccine against N. gonorrhoeae, rapid identification and proper treatment are essential to prevent the infection.Following the emergence of resistance to ESCs, in particular cefixime, the guidelines for the antimicrobial treatment of gonorrhoea have been reviewed and shared internationally. The current scheme recommends the use of a combination of two antimicrobials: a single intramuscular dose of ceftriaxone plus a single dose of orally administered azithromycin. Most worryingly, the reporting of multidrug-resistant (MDR) strains in many geographic areas impels renewed efforts for prevention approaches. New drugs are under evaluation in vitro and ongoing research in the vaccine area is in progress. Due to the high global antimicrobial resistance (AMR) among gonococcal population, the strengthening of a timely surveillance to examine trends over time and to identify and respond to clinically significant changes in the coming years along with monitoring treatment failures are the keys to control the disease.