Review

Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea

* Author for correspondence

WHO Collaborating Centre for Gonorrhoea & Other STIs, National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital, SE-701 85 Örebro, Sweden.

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Email the corresponding author at magnus.unemo@orebroll.se

Robert A Nicholas

Departments of Pharmacology & Microbiology & Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA

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Published Online:12 Dec 2012https://doi.org/10.2217/fmb.12.117

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Abstract

The new superbug Neisseria gonorrhoeae has retained resistance to antimicrobials previously recommended for first-line treatment and has now demonstrated its capacity to develop resistance to the extended-spectrum cephalosporin, ceftriaxone, the last remaining option for first-line empiric treatment of gonorrhea. An era of untreatable gonorrhea may be approaching, which represents an exceedingly serious public health problem. Herein, we review the evolution, origin and spread of antimicrobial resistance and resistance determinants (with a focus on extended-spectrum cephalosporins) in N. gonorrhoeae, detail the current situation regarding verified treatment failures with extended-spectrum cephalosporins and future treatment options, and highlight essential actions to meet the large public health challenge that arises with the possible emergence of untreatable gonorrhea. Essential actions include: implementing action/response plans globally and nationally; enhancing surveillance of gonococcal antimicrobial resistance, treatment failures and antimicrobial use/misuse; and improving prevention, early diagnosis and treatment of gonorrhea. Novel treatment strategies, antimicrobials (or other compounds) and, ideally, a vaccine must be developed.

Keywords:

Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

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Financial & competing interests disclosure

Research at the WHO Collaborating Centre for Gonorrhoea and other STIs is supported by grants from the WHO, the Örebro County Council Research Committee and the Foundation for Medical Research at Örebro University Hospital, Sweden (M Unemo). Research by RA Nicholas is supported by grants from the National Institutes of Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

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