Go Go Gonorrhoeae

Antibiotic resistance is nothing new in the world of health care. Most deaths related to antibiotic resistant bacteria are in health care settings, such as hospitals and nursing homes. However, there is an organism that is causing concern for those outside of these environments, and that is Neisseria gonorrhoeae (also known as "the clap").

3D computer-generated image
of drug-resistant N. gonorrhoeae
Image courtesy of CDC

N. gonorrhoeae is one of several species of the genus Neisseria, which contains both normal flora and pathogens of humans and animals. N. gonorrhoeae is a common sexually transmitted disease that causes infection in the genitals, rectum, and throat, and can also be spread to an infant from an infected mother during childbirth. Symptoms of infection include a burning sensation when urinating, a yellow, green, or white discharge from the penis, and occasionally painful or swollen testicles. Most infected women are asymptomatic, and those that have symptoms are often mild and mistaken for a bladder or vaginal infection. All infected women are susceptible to serious complications, characterized by painful or burning sensation when urinating, increased vaginal discharge, and vaginal bleeding between menstrual cycles. Signs of symptomatic rectal infections are discharge, anal itching, soreness, bleeding, and painful bowel movements.

Figure Courtesy of CDC

N. gonorrhoeae is becoming a health concern because it has developed resistance to sulfonilamide, penicillin, tetracycline, and fluoroquinolone (ex. ciproflaxin) antibiotics. N. gonorrhoeae is readily able to develop resistance, which would complicate treatment, since there are few options left that are simple, well-studied, well-tolerated, and highly effective. The current recommended therapy is cephalosporin ceftriaxone plus either azithromycin or doxycycline. N. gonorrhoeae is under surveillance by the Gonococcal Isolate Surveillance Project (GISP), established in 1986.

Figure courtesy of CDC

Clinicians are asked to report any N. gonorrhoeae specimen that demonstrates decreased cephalosporin susceptibility and any cephalosporin treatment failure. Outside the U.S., ceftriaxone-resistant N. gonorrhoeae have already been reported in Japan and South Africa.