Antibiotic resistance in gonorrhea

Gram stain of Neisseria gonorrhoeae showing characteristic diplococci morphology

Neisseria gonorrhoeae, the bacterium that causes the sexually transmitted infection gonorrhea, has developed antibiotic resistance to many antibiotics. The bacteria was first identified in 1879.[1]

In the 1940s effective treatment with penicillin became available, but by the 1970s resistant strains predominated. Resistance to penicillin has developed through two mechanisms: chromosomally mediated resistance (CMRNG) and penicillinase-mediated resistance (PPNG). CMRNG involves step wise mutation of penA, which codes for the penicillin-binding protein (PBP-2); mtr, which encodes an efflux pump that removes penicillin from the cell; and penB, which encodes the bacterial cell wall porins. PPNG involves the acquisition of a plasmid-borne beta-lactamase.[2] N. gonorrhoeae has a high affinity for horizontal gene transfer, and as a result, the existence of any strain resistant to a given drug could spread easily across strains.[citation needed]

Cases of Neisseria Gonorrhoeae with decreased susceptibility or resistance to antibiotics (2017-2018).

Fluoroquinolones were a useful next-line treatment until resistance was achieved through efflux pumps and mutations to the gyrA gene, which encodes DNA gyrase.[2] Third-generation cephalosporins have been used to treat gonorrhoea since 2007, but resistant strains have emerged. As of 2010, the recommended treatment is a single 250 mg intramuscular injection of ceftriaxone, sometimes in combination with azithromycin or doxycycline.[3][4] However, certain strains of N. gonorrhoeae can be resistant to antibiotics that are normally used to treat it. These include: cefixime (an oral cephalosporin), ceftriaxone (an injectable cephalosporin), azithromycin, aminoglycosides, and tetracycline.[5][6]

  1. ^ Ligon BL (2005). "Albert Ludwig Sigesmund Neisser: discoverer of the cause of gonorrhea". Semin Pediatr Infect Dis. 16 (4): 336–41. doi:10.1053/j.spid.2005.07.001. PMID 16210113.
  2. ^ a b Tapsall, John (2001). "Antimicrobial resistance in Neisseria gonorrhoeae". World Health Organization. hdl:10665/66963.
  3. ^ Deguchi T, Nakane K, Yasuda M, Maeda S (September 2010). "Emergence and spread of drug resistant Neisseria gonorrhoeae". J. Urol. 184 (3): 851–8, quiz 1235. doi:10.1016/j.juro.2010.04.078. PMID 20643433.
  4. ^ Centers for Disease Control Prevention (CDC). (Aug 10, 2012). "Update to CDC's Sexually Transmitted Diseases Treatment Guidelines, 2010: Oral Cephalosporins No Longer a Recommended Treatment for Gonococcal Infections". MMWR. Morbidity and Mortality Weekly Report. 61 (31): 590–4. PMID 22874837.
  5. ^ "Biggest Threats - Antibiotic/Antimicrobial Resistance - CDC". www.cdc.gov. Retrieved 2016-05-05.
  6. ^ Pleininge, Sonja (April 2022). "Extensively drug-resistant (XDR) Neisseria gonorrhoeae causing possible gonorrhoea treatment failure with ceftriaxone plus azithromycin in Austria, April 2022". Euro Surveillance. 27 (24). doi:10.2807/1560-7917.ES.2022.27.24.2200455. PMC 9205165. PMID 35713023. S2CID 249747652.