In 2020, WHO estimated that Neisseria gonorrhoeae caused 82·4 million new cases of gonorrhoea among those aged 15–49 years worldwide. Without effective treatment, the morbidity associated with gonorrhoea complications can be considerable. Additionally, N gonorrhoeae infection enhances the risk of acquiring or transmitting HIV.

N gonorrhoeae has developed resistance to all current and previously used classes of antibiotics used to treat gonorrhoea, with ceftriaxone the sole remaining empirical treatment option for first-line gonorrhoea monotherapy. In 2017–18, the WHO Gonococcal Antimicrobial Surveillance Programme (GASP) reported high global rates of fluoroquinolone resistance, increasing azithromycin resistance, and, worryingly, progressively increasing multidrug resistance, including to extended-spectrum cephalosporins, such as ceftriaxone. Resistance patterns vary considerably by region; the WHO Enhanced GASP has highlighted situations of particular concern in Cambodia and Viet Nam. In 2022, nearly a third of isolates (32%) in Cambodia showed resistance to either broad-spectrum cephalosporins or azithromycin (with 7% showing resistance to both), and in Viet Nam, 27% of isolates were resistant to ceftriaxone in 2023. The WHO global action plan highlighted the development of new antibiotics for gonorrhoea as a high priority, and in 2019 the US Centers for Disease Control and Prevention declared antimicrobial-resistant N gonorrhoeae an urgent public health threat.

 

Authors

Alison Luckey, Manica Balasegaram, Lindley A Barbee, Teresa A Batteiger, Helen Broadhurst, Stephanie E Cohen, Sinead Delany-Moretlwe, Henry J C de Vries, Jodie A Dionne, Katherine Gill, Chris Kenyon, Rossaphorn Kittiyaowamarn, Drew Lewis, John P Mueller, Vimla Naicker, Seamus O’Brien, John P O’Donnell, Nittaya Phanuphak, Elizabeth Spooner, Subasree Srinivasan, Stephanie N Taylor, Magnus Unemo, Zinhle Zwane, Edward W Hook 3rd, for the Zoliflodacin Phase 3 Study Group*

 

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