Antibiotic resistant gonococci: past, present and future

Abstract

Gonorrhoea remains one of the commonest STIs from a global perspective and, left untreated or treated inadequately, may result in serious complications such as epidiymo-orchitis and pelvic inflammatory disease and their adverse sequelae. Since the introduction of sulphonamides in the 1930’s, the gonococcus has shown itself to be a master of adaptability and has acquired a number of chromosomal and plasmid-mediated antibiotic resistance mechanisms. The continual development and spread of in vivo resistant strains has resulted in several key changes in recommended therapy for gonorrhoea over past decades. The recent emergence of quinolone resistance among gonococci isolated in South Africa now threatens to undermine the success of the syndromic management approach to date. Within South Africa, there is now an urgent need to change first-line therapy away from ciprofloxacin to a third generation cephalosporin. With the lack of new therapeutic agents on the horizon, a future with multi-drug therapy as the main management strategy for antibiotic resistant gonorrhoea looks inevitable. The importance of condoms in the prevention of gonococcal transmission should not be under-estimated and STI prevention efforts should be increased.