The continuing evolution of antibiotic resistance in Neisseria gonorrhoeae: past, present and future threats to effective treatment.

Gonorrhoea constitutes a global public health threat. Although a range of antibiotics have been available to treat gonococcal infections for more than 80 years, Neisseria gonorrhoeae has shown remarkable versatility in its ability to develop resistance to successive classes of drugs. As a result, national and international treatment guidelines have had to be regularly updated to take account of increases in the prevalence of gonococcal strains resistant to recommended antibiotics. Even when particular antibiotics are no longer empirically used to treat gonorrhoea, N. gonorrhoeae often retains resistance, with strains becoming MDR over time. Future efforts to ensure gonorrhoea remains a treatable infection will require a multidisciplinary global approach including efforts to provide widely available and affordable diagnostic testing, robust international surveillance of resistance, and the development of new antibiotics coupled with enhanced antimicrobial stewardship to ensure optimal use of both new and older antimicrobial agents.