Background

Reports of a gonorrhoea ‘superbug’ made the headlines last year following the description of a ceftriaxone-resistant isolate of Neisseria gonorrhoeae.1 But is antimicrobial resistance a significant problem and what is the current reality of N. gonorrhoeae infection in the UK? Is gonorrhoea getting meaner?

Anogenital infection with N. gonorrhoeae has been highly responsive to single-dose antimicrobial treatment since the introduction of penicillin. However, the progressive development of resistance by N. gonorrhoeae to many classes of antimicrobial has necessitated periodic changes in treatment recommendations to maintain treatment efficacy and led to ever diminishing treatment options. Third-generation cephalosporins, notably ceftriaxone and cefixime, have been the mainstay of treatment recommendations since 2004. Surveillance data in the UK show a progressive drift in the minimum inhibitory concentrations (MICs) of ceftriaxone and cefixime to N. gonorrhoeae,2 culminating in multiple case reports of treatment failure with cefixime,3,–,5 three case reports of ceftriaxone failure in the treatment of pharyngeal gonorrhoea6 7 and the identification of the ceftriaxone-resistant isolate in Japan in 2011.1 There is growing concern that gonorrhoea may become untreatable unless new treatments can be found or new control strategies implemented. The prevention of sexually transmitted infections (STIs) assumes added importance and urgency with the prospect of another incurable infection.

Symptoms and treatment

The common symptoms of gonorrhoea are similar to those caused by infection with Chlamydia …