title: Global resistance of Neisseria gonorrhoeae: when theory becomes reality.
abstract: OBJECTIVE
  Neisseria gonorrhoeae has demonstrated a remarkable genetic capacity to acquire antimicrobial resistance (AMR) determinants. This review focuses on the recent developments in respect of third generation extended spectrum cephalosporin (ESC)-resistant gonorrhoea and the search for future treatment options.
  
  
  RESULTS
  The estimated incidence of new gonorrhoea cases is increasing, and the antimicrobial resistance profile of N. gonorrhoeae is worsening. The most significant recent finding has been the emergence of extensively drug-resistant (XDR) N. gonorrhoeae characterized by very high ceftriaxone minimum inhibitory concentrations. A national switch from cefixime to high-dose ceftriaxone as first-line antigonococcal therapy in England and Wales, as well as parts of Japan, has been accompanied by a reduction in the prevalence of oral ESC-resistant gonococci. Azithromycin given in combination with either gentamicin or gemifloxacin has been shown to be an effective alternative antigonococcal therapy. Both ertapenem and solithromycin have good in-vitro activity against ESC-resistant N. gonorrhoeae strains.
  
  
  CONCLUSIONS
  Current strategies to control gonococcal AMR should focus on the use of higher doses of ceftriaxone given as part of dual therapy and further evaluation of alternative drug combinations. The emergence of XDR gonorrhoea argues for enhanced efforts to develop novel antimicrobial agents and a gonococcal vaccine.
authors.affiliation: aCentre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service bDepartment of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg cDivision of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001428:Bacterial Vaccines; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006069:Gonorrhea / Q000188:drug therapy*; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D001428:Bacterial Vaccines; D002511:Cephalosporins