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Review
. 2025 Feb;44(2):233-250.
doi: 10.1007/s10096-024-04968-8. Epub 2024 Nov 27.

Management and prevention of Neisseria meningitidis and Neisseria gonorrhoeae infections in the context of evolving antimicrobial resistance trends

Helen S Marshall  1 , Jean-Michel Molina  2   3 , Valérie Berlaimont  4 , Aruni Mulgirigama  5 , Woo-Yun Sohn  6 , Béatrice Berçot  7   8 , Shravani Bobde  9
Affiliations
Review

Management and prevention of Neisseria meningitidis and Neisseria gonorrhoeae infections in the context of evolving antimicrobial resistance trends

Helen S Marshall et al. Eur J Clin Microbiol Infect Dis. 2025 Feb.

Abstract

Purpose: To describe the relationships between Neisseria meningitidis (NM) and Neisseria gonorrhoeae (NG) at genetic, population, and individual levels; to review historical trends in antimicrobial resistance (AMR); to review the treatment and preventive landscapes and explore their potential impact on AMR.

Methods: A narrative literature search was conducted in PubMed, with searches restricted to 2003-2023 and additional articles included based on expertise.

Results: NM and NG are closely related bacterial pathogens causing invasive meningococcal disease (IMD) and gonorrhea, respectively. NM can currently be treated with most antibiotics and generally has a wild-type susceptibility profile, whereas NG is increasingly resistant even in the first line of treatment. These pathogens share 80-90% genetic identity and can asymptomatically cohabit the pharynx. While AMR has historically been rare for NM, recent reports show this to be an emerging clinical concern. Extensively drug-resistant NG are reported globally, with data available from 73 countries, and can lead to treatment failure. Importantly, Neisseria commensals within the normal microbiota in the pharynx can act as a genetic reservoir of resistance to extended-spectrum cephalosporins. Novel oral antibiotics are urgently needed to treat a growing threat from antibiotic-resistant NG, recognized as a major global concern to public health by the World Health Organization. Numerous vaccines are available to prevent IMD, but none are approved for gonorrhea. Research to identify suitable candidates is ongoing.

Conclusion: Holistic management of AMR in IMD and gonorrhea should couple judicious use of existing antibiotics, optimization of vaccination programs, and development of novel antibiotics and vaccines.

Keywords: Antibiotics; Antimicrobial resistance; Gonorrhea; Meningitis; Vaccines.

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Conflict of interest statement

Declarations. Competing interests: Author HSM is an investigator on clinical trials sponsored by Industry including Iliad, Pfizer, Moderna, and Seqirus. Author HSM’s institution receives funding for sponsored studies from GSK, Pfizer, Sanofi-Pasteur. Author HSM receives no personal funding from Industry. Authors SB, AM, VB, and WS are employees of GSK and may hold stock or stock options. Author SB holds patents on antimicrobial peptides and related methods issued prior to employment at GSK and before this work began. Author JM has received institutional grants and personal fees for advisory boards from Gilead, Helix, and Merck. Author BB declares no financial or non-financial competing interests.

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