title: Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future.
abstract: Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae, including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.
authors: WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
authors: Magnus
authors: M
authors: Unemo
authors: Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, Georgia, USA wshafer@emory.edu.
authors: William M
authors: WM
authors: Shafer
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D059647:Gene-Environment Interaction; D056084:Genetic Fitness; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000266:history / Q000382:microbiology*; D049674:History, 21st Century; D006801:Humans; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000502:physiology*
chemical_list: D000890:Anti-Infective Agents