title: Antimicrobial Resistance Expressed by Neisseria gonorrhoeae: A Major Global Public Health Problem in the 21st Century.
abstract: Neisseria gonorrhoeae is a strictly human pathogen that is typically transmitted by sexual contact. The associated disease gonorrhea has plagued humankind for thousands of years, with a current estimated incidence of 78 million cases per year. Advances in antimicrobial discovery in the 1920s and 1930s leading to the discovery of sulfonamides and penicillin begun the era of effective antimicrobial treatment of gonorrhea. Unfortunately, the gonococcus developed decreased susceptibility or even resistance to these initially employed antibiotics, a trend that continued over subsequent decades with each new antibiotic that was brought into clinical practice. As this pattern of resistance has continued into the 21st century, there is now reason for great concern, especially in an era when few new antibiotics have prospects for use as treatment of gonorrhea. Here, we review the history of gonorrhea treatment regimens and gonococcal resistance to antibiotics, the mechanisms of resistance, resistance monitoring schemes that exist in different international settings, global responses to the challenge of resistance, and prospects for future treatment regimens in the 21st century.
authors.affiliation: WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, SE-701 85 Örebro, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Unemo
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health of Emory University and Department of Medicine, Division of Infectious Diseases.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.affiliation: Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA 30322.|Veterans Affairs Medical Center (Atlanta), Decatur, GA 30033.
authors.forename: William M
authors.initials: WM
authors.lastname: Shafer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D006069:Gonorrhea / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009344:Neisseria gonorrhoeae / Q000187:drug effects* / Q000235:genetics; D011634:Public Health
chemical_list: D000900:Anti-Bacterial Agents