Current Susceptibility Surveillance and Distribution of Antimicrobial Resistance in N. gonorrheae within WHO Regions

Abstract

Neisseria gonorrhoeae (N. gonorrhoeae) is the etiological agent of the second most common sexually transmitted disease in the world, gonorrhoea. Currently recommended and last available first-line therapy is extended-spectrum cephalosporins most often combined with azitromycin. However, misuse of antibiotics and the abilities of N. gonorrhoeae to acquire new genetic and plasmid-borne resistance determinants has gradually led to the situation where this bacterium has become resistant to all major classes of antibiotics. Together with a generally slow update of treatment guidelines globally, as well as with the high capacity of gonococci to develop and retain AMR, this may lead to the global worsening of gonococcal AMR. Since effective vaccines are unavailable, the management of gonorrhoea relies mostly on prevention and accurate diagnosis, together with antimicrobial treatment. The study overviews the latest results of mostly WHO-initiated studies, primarily focusing on the data regarding the molecular basis of the resistance to the current and novel most promising antibacterial agents, which could serve to establish or reinforce the continual, quality-assured and comparable AMR surveillance, including systematic monitoring and treatment with the use of molecular AMR prediction methods.

Keywords: Neisseria gonorrhoeae; WHO regions; antimicrobial resistance; resistance genes; surveillance.

Figure 1

The percentage of isolates with decreased susceptibility or resistance to ceftriaxone according to the most recent data available for represented countries. Data were collected from references: [16,30,40,41,42,43,44,45,46,47,48,49,50].

Figure 2

The percentage of isolates with decreased susceptibility or resistance to azithromycin according to the most recent data available for represented countries. Data were collected from references: [16,30,41,42,44,46,47,48,50,51].