A Review on Antimicrobial Resistant Gonorrhoea
Journal Title: International Journal of Science and Innovative Research - Year 2021, Vol 2, Issue 01
Abstract
The bacterium Neisseria gonorrhoeae causes the sexually transmitted infection (STI) gonorrhoea, which has an estimated global annual incidence of 86.9 million adults. Gonorrhoea can present as urethritis in men, cervicitis or urethritis in women, and in extra genital sites (pharynx, rectum, conjunctiva and, rarely, systemically) in both sexes [1:18:19:20]. Its causative agent, Neisseria gonorrhoeae, has shown a remarkable flexibility to adapt and become resistant to all antimicrobials introduced over the past century for gonococcal therapy. The currently last available first-line therapy that is recommended in most countries is ceftriaxone. However, resistance levels against ceftriaxone are rising globally and incidences of confirmed treatment failure are increasingly encountered, particularly with the global spreading of the ceftriaxone-resistant FC428 clone in recent years. Resistance against most antimicrobials has been the result of adaptive genomic mutations that reduce affinity of the antimicrobial to its target protein or rRNA [2]. Confirmation of the diagnosis requires microscopy of Gram- stained samples, bacterial culture or nucleic acid amplification tests. As no gonococcal vaccine is available, prevention relies on promoting safe sexual behaviors. Improved global surveillance of the emergence, evolution, fitness, and geographical and temporal spread of AMR in N. gonorrhoeae, and improved understanding of the pharmacokinetics and pharmacodynamics for current and future antimicrobials in the treatment of urogenital and extra genital gonorrhoeae, are essential to inform treatment guidelines. Key priorities for gonorrhoea control include strengthening prevention, early diagnosis, and treatment of patients and their partners; decreasing stigma; expanding surveillance of AMR and treatment failures; and promoting responsible antimicrobial use [1:18:19:20]. To ensure gonococcal treatment remains available in the future, both alternative clinically approved antimicrobials and novel antimicrobials have been intensely studied both in gonococcal susceptibility analyses and clinical efficacy trials. Although there have been some limited successes, all studied alternative therapies that reached clinical trials have displayed some shortcomings in their efficacy against pharyngeal infections and/or overlapping resistance determinants with previously or currently used antimicrobials. This review summarizes the development of gonococcal antimicrobial resistance over the past century, describes the mechanisms involved in antimicrobial resistance, and provides an overview of the alternative therapies that have been under investigation this past decade [2].
Authors and Affiliations
Alshifa Malek, Janvi Patel, Dharmendra Singh Rajput
Keywords
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