Antimicrobial resistance in Neisseria gonorrhoeae: history, molecular mechanisms and epidemiological aspects of an emerging global threat

Abstract

Neisseria gonorrhoeae is the agent of gonorrhea, a sexually transmitted infection with an estimate from The World Health Organization of 78 million new cases in people aged 15-49 worldwide during 2012. If left untreated, complications may include pelvic inflammatory disease and infertility. Antimicrobial treatment is usually effective; however, resistance has emerged successively through various molecular mechanisms for all the regularly used therapeutic agents throughout decades. Detection of antimicrobial susceptibility is currently the most critical aspect for N. gonorrhoeae surveillance, however poorly structured health systems pose difficulties. In this review, we compiled data from worldwide reports regarding epidemiology and antimicrobial resistance in N. gonorrhoeae, and highlight the relevance of the implementation of surveillance networks to establish policies for gonorrhea treatment.

Keywords: Neisseria gonorrhoeae; Resistance mechanisms; Surveillance.

Fig. 1

Evolution of Neisseria gonorrhoeae resistance to antimicrobials. Color changes indicate events that impacted the level of resistance along the time each antimicrobial was used. Sulfonamide: introduction, resistance reported, combined use with trimethoprim; penicillin and tetracycline: introduction, chromosomally-mediated resistance reported, plasmid-mediated resistance reported; ciprofloxacin: introduction, resistance reported; azithromycin: introduction, resistance reported, high level resistance reported; cefixime or ceftriaxone: introduction, reduced susceptibility reported.