Antimicrobial Resistance in Neisseria gonorrhoeae

Neisseria gonorrhoeae has developed resistance to every antimicrobial previously recommended for treatment, so there is only 1 remaining Centers for Disease Control and Prevention (CDC)-recommended treatment regimen: dual therapy with intramuscular ceftriaxone 250 mg plus oral azithromycin 1 g. However, gonococcal susceptibility to cephalosporins, including ceftriaxone, has declined, suggesting that cephalosporin resistance is inevitable. To prevent the emergence and transmission of cephalosporin-resistant gonorrhea, clinicians should treat gonorrhea with the CDC-recommended regimen and maintain vigilance for treatment failures. Public health priorities for mitigating the effect of cephalosporin resistance include facilitating access to gonococcal culture and antimicrobial susceptibility testing. New treatment options are urgently needed.