The role of antimicrobial resistance monitoring in Neisseria gonorrhoeae

Abstract

Treatment regimens for most sexually transmitted diseases of bacterial origin are well established. For example, treatment of infections with Chlamydia trachomatis is usually now with macrolides, and Treponema pallidum is still reliably susceptible to penicillins. However, antibiotic treatment for gonorrhoea is more complicated because of the propensity of the gonococcus to develop antimicrobial resistance (AMR), so that standard treatment protocols for gonorrhoea require regular review. Additionally, treatment for gonorrhoea is usually by means of a single dose regimen (for better compliance with treatment) and is best given at first presentation/diagnosis (to reduce the potential for disease spread). Testing of individual isolates on an emerging basis is not a practical means of guiding treatment for this situation. Thus, standardised treatments are determinedfrom an epidemiologically-based assessment of the susceptibility of gonococci prevalent in a region or community. Another complicating factor for treatment of gonococcal infection is the frequency of gene recombination in Neisseria gonorrhoeae that results in continuing rearrangement of and within gonococcal populations. AMR patterns within different sexual networks are also affected and, in addition to changes over time, patterns of resistance also differ substantially in different parts of Australia.