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The serious threat of multidrug-resistant and untreatable gonorrhoea: the pressing need for global action to control the spread of antimicrobial resistance, and mitigate the impact on sexual and reproductive health
  1. Francis Ndowa1,2,
  2. Manjula Lusti-Narasimhan3,
  3. Magnus Unemo4
  1. 1Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  2. 2STI Specialist and Consultant, Harare, Zimbabwe
  3. 3Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  4. 4World Health Organization Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to Dr Manjula Lusti-Narasimhan, Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland; lustinarasimhanm{at}

Statistics from

STIs remain a major cause of morbidity and mortality worldwide. The WHO estimated that >498 million new cases of syphilis, gonorrhoea, chlamydial infection and trichomoniasis occurred globally in 2008 in adults (15–49 years of age). More than 106 million were gonococcal infections.1 Accordingly, gonorrhoea remains a major global public health problem with serious health, social and economic consequences. Inadequate control and treatment can result in severe complications, such as pelvic inflammatory disease, leading to infertility or ectopic pregnancy, and neonatal eye infections which can cause blindness. Up to 10% of women who remain untreated (or inadequately treated) for chlamydial and gonococcal infections may become infertile. Urogenital gonorrhoea is also asymptomatic in at least 50% of women, which leaves the infections undetected and untreated with the risk of severe complications. On a global scale, up to 4000 newborn babies, annually, may become blind because of gonococcal and chlamydial ophthalmia neonatorum.2 In men, gonococcal infections cause symptomatic urethritis which, if untreated, can result in epididymitis in 10%–30% of cases,w1 that may lead to infertility. Gonorrhoea also significantly enhances the transmission of HIV. The burden of gonococcal infections is highest in countries that are least able to manage them because of several factors, including stigma, inadequate resources and lack of appropriate diagnostics, surveillance and antimicrobial treatment. The problem is further compounded by the ability of Neisseria gonorrhoeae to develop antimicrobial resistance (AMR) within a relatively short time span.3 w2 w3

Historically, since the advent of the antibiotic era, …

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