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Gonorrhoea

Nature Reviews Disease Primers volume 5, Article number: 79 (2019) Cite this article

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Abstract

The bacterium Neisseria gonorrhoeae causes the sexually transmitted infection (STI) gonorrhoea, which has an estimated global annual incidence of 86.9 million adults. Gonorrhoea can present as urethritis in men, cervicitis or urethritis in women, and in extragenital sites (pharynx, rectum, conjunctiva and, rarely, systemically) in both sexes. Confirmation of diagnosis requires microscopy of Gram-stained samples, bacterial culture or nucleic acid amplification tests. As no gonococcal vaccine is available, prevention relies on promoting safe sexual behaviours and reducing STI-associated stigma, which hinders timely diagnosis and treatment thereby increasing transmission. Single-dose systemic therapy (usually injectable ceftriaxone plus oral azithromycin) is the recommended first-line treatment. However, a major public health concern globally is that N. gonorrhoeae is evolving high levels of antimicrobial resistance (AMR), which threatens the effectiveness of the available gonorrhoea treatments. Improved global surveillance of the emergence, evolution, fitness, and geographical and temporal spread of AMR in N. gonorrhoeae, and improved understanding of the pharmacokinetics and pharmacodynamics for current and future antimicrobials in the treatment of urogenital and extragenital gonorrhoea, are essential to inform treatment guidelines. Key priorities for gonorrhoea control include strengthening prevention, early diagnosis, and treatment of patients and their partners; decreasing stigma; expanding surveillance of AMR and treatment failures; and promoting responsible antimicrobial use and stewardship. To achieve these goals, the development of rapid and affordable point-of-care diagnostic tests that can simultaneously detect AMR, novel therapeutic antimicrobials and gonococcal vaccine(s) in particular is crucial.

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Fig. 1: Recommended empirical therapy for gonorrhoea and emergence of AMR in Neisseria gonorrhoeae.
Fig. 2: Estimated new global cases of gonorrhoea in 2016.
Fig. 3: N. gonorrhoeae cell envelope structure.
Fig. 4: N. gonorrhoeae infection.

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Acknowledgements

The authors are grateful to S. Jacobsson (Örebro University Hospital and Örebro University) and S. Perera and N. Parmar (University of Saskatchewan) for technical assistance with preparing this manuscript.

Reviewer information

Nature Reviews Disease Primers thanks G. Hughes, S. Sood and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. World Health Organization Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Magnus Unemo

  2. National Reference Laboratory for Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden

    Magnus Unemo

  3. Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    H Steven Seifert

  4. Departments of Medicine, Epidemiology and Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Edward W. Hook III

  5. Institute for Global Health, University College London, London, UK

    Sarah Hawkes

  6. Skin and Genitourinary Medicine Clinic, Harare, Zimbabwe

    Francis Ndowa

  7. Department of Biochemistry, Microbiology and Immunology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Jo-Anne R. Dillon

  8. Vaccine and Infectious Disease Organization — International Vaccine Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Jo-Anne R. Dillon

Authors
  1. Magnus Unemo
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  2. H Steven Seifert
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Contributions

Introduction (M.U.); Epidemiology (F.N.); Mechanisms/pathophysiology (H S.S.); Diagnosis, screening and prevention (J.-A.R.D.); Management (E.W.H.III); Quality of life (S.H.); Outlook (M.U.); Overview of Primer (M.U.).

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Unemo, M., Seifert, H.S., Hook, E.W. et al. Gonorrhoea. Nat Rev Dis Primers 5, 79 (2019). https://doi.org/10.1038/s41572-019-0128-6

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