New microbes and new infections · 2026
Antimicrobial resistance crisis in STIs: Gonorrhea and M. genitalium on the brink of untreatability.
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Ghodsi Nafiseh, Arezoomand Roghayeh, Azimian Amir
Аннотация
BACKGROUND: Antimicrobial resistance (AMR) in sexually transmitted infections (STIs), especially Neisseria gonorrhoeae and Mycoplasma genitalium, is a growing global health crisis. These pathogens are developing resistance to first-line treatments like ceftriaxone and macrolides, risking untreatable infections. This review examines resistance trends, treatment challenges, and emerging solutions.
METHODS: A systematic analysis of epidemiological data, molecular studies, and clinical trials was performed. Key resistance markers (e.g., penA mosaics in N. gonorrhoeae, 23S rRNA mutations in M. genitalium) and treatment outcomes were assessed. Data sources included WHO reports, peer-reviewed studies (2010-2024), and phase II/III trials of new drugs like zoliflodacin and gepotidacin.
RESULTS: N. gonorrhoeae resists all previously effective antibiotics, with ceftriaxone-resistant strains (e.g., FC428 clone) spreading via penA-60.001 alleles. Dual resistance to ceftriaxone/azithromycin is emerging. M. genitalium shows high macrolide (23S rRNA mutations) and fluoroquinolone (parC/gyrA mutations) resistance (>50% in some regions), complicating therapy. While zoliflodacin and gepotidacin show promise, pre-existing resistance (e.g., GyrB D443N) threatens efficacy. Third-line options (pristinamycin, sitafloxacin) have limited availability and effectiveness.
DISCUSSION: The AMR crisis in STIs requires urgent action, including improved surveillance, resistance-guided therapy, and rapid diagnostics. Investment in new antibiotics and alternative approaches (e.g., doxycycline prophylaxis) is crucial. Global public health efforts are needed to curb resistance and prevent untreatable STIs.
METHODS: A systematic analysis of epidemiological data, molecular studies, and clinical trials was performed. Key resistance markers (e.g., penA mosaics in N. gonorrhoeae, 23S rRNA mutations in M. genitalium) and treatment outcomes were assessed. Data sources included WHO reports, peer-reviewed studies (2010-2024), and phase II/III trials of new drugs like zoliflodacin and gepotidacin.
RESULTS: N. gonorrhoeae resists all previously effective antibiotics, with ceftriaxone-resistant strains (e.g., FC428 clone) spreading via penA-60.001 alleles. Dual resistance to ceftriaxone/azithromycin is emerging. M. genitalium shows high macrolide (23S rRNA mutations) and fluoroquinolone (parC/gyrA mutations) resistance (>50% in some regions), complicating therapy. While zoliflodacin and gepotidacin show promise, pre-existing resistance (e.g., GyrB D443N) threatens efficacy. Third-line options (pristinamycin, sitafloxacin) have limited availability and effectiveness.
DISCUSSION: The AMR crisis in STIs requires urgent action, including improved surveillance, resistance-guided therapy, and rapid diagnostics. Investment in new antibiotics and alternative approaches (e.g., doxycycline prophylaxis) is crucial. Global public health efforts are needed to curb resistance and prevent untreatable STIs.