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Review
. 2016 Jun;4(3):10.1128/microbiolspec.EI10-0009-2015.
doi: 10.1128/microbiolspec.EI10-0009-2015.

Antimicrobial Resistance Expressed by Neisseria gonorrhoeae: A Major Global Public Health Problem in the 21st Century

Magnus Unemo  1 , Carlos Del Rio  2 , William M Shafer  3   4
Affiliations
Review

Antimicrobial Resistance Expressed by Neisseria gonorrhoeae: A Major Global Public Health Problem in the 21st Century

Magnus Unemo et al. Microbiol Spectr. 2016 Jun.

Abstract

Neisseria gonorrhoeae is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.

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Figures

Figure 1
Figure 1
Gonococcal Isolate Surveillance Project (GISP) sentinel sites and regional laboratories in 2015 ( http://www.cdc.gov/std/gisp/gisp-map.htm)
Figure 2
Figure 2
Gonococcal Isolate Surveillance Project (GISP) antimicrobial testing panel with Clinical and Laboratory Standards Institute (CLSI) breakpoints in 2014
Figure 3
Figure 3. Prevalence (%) of resistance in Neisseria gonorrhoeae in the US Gonococcal Isolate Surveillance Project (GISP) from 2000 to 2014
R, resistance; RS, reduced susceptibility
Figure 4
Figure 4
Antimicrobials used to treat gonorrhea in the USA from 1988 to 2013 (figure obtained from http://www.cdc.gov/std/gisp/gisp2013.htm)
See this image and copyright information in PMC

References

    1. World Health Organization (WHO), Department of Reproductive Health and Research. Neisseria gonorrhoeae. Geneva: WHO; 2012. Global action plan to control the spread and impact of antimicrobial resistance in; pp. 1–36.
    1. Bignell C, Unemo M. 2012 European guideline on the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS. 2013;24:85–92. - PubMed
    1. Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, Zimba D, Vernazza PL, Maida M, Fiscus SA, Eron JJ., Jr Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet. 1997;349:1868–1873. - PubMed
    1. Tapsall JW, Ndowa F, Lewis DA, Unemo M. Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. 2009;7:821–834. - PubMed
    1. Unemo M, Ison C. Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO); 2013. Gonorrhoea.

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