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Prevention strategies will be the first-line approach to control the spread of antimicrobial resistance in Neisseria gonorrhoeae, but the next option will be the provision of an efficacious antimicrobial agent. In view of the threat of N gonorrhoeae becoming increasingly less susceptible to the cephalosporins and occasional cases of treatment failure being reported worldwide, treatment of gonorrhoea has become a public health issue requiring a global response. The mix of articles in this supplement is an attempt to assess the current position and activities taking place globally to respond to the threat of untreatable gonorrhoea and highlight the gaps and shortfalls that need to be tackled. Some of the key findings as each region takes stock are as follows:
The highlights of gaps and shortfalls
There is a lack of systematic surveillance in some countries of the world. For example, the article summarising the situation in Africa points to the lack of good surveillance systems for sexually transmitted infections (STIs) in general and virtually no systematic or regular surveillance for antimicrobial susceptibility of gonorrhoea. The question posed in one of the papers is what would be the best way to establish antimicrobial susceptibility surveys at the national level.
There is a lack of adequate laboratory facilities, clinical skills and human resource to monitor antimicrobial resistance patterns. Most of the countries in Africa and a significant number in south-east Asia adopted the syndromic approach to the diagnosis and management of STIs. This has resulted in a loss of a number of laboratory skills including collecting and processing genital swabs, culturing N gonorrhoeae and performing antimicrobial susceptibility testing, and re-training is required.
In better-resourced countries, the availability of advanced diagnostic tools, such as nucleic acid amplification tests has replaced culture-based methods for the diagnosis of gonorrhea, and again the basic laboratory skills have been reduced …
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