Antibiotic resistance in gonorrhea

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.

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.
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