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Gonorrhoea, a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae, is a global public health problem. The World Health Organization has estimated that there were 62 million new cases of gonorrhoea worldwide in 1999.1 Population prevalence can be high, particularly in countries with developing or emerging economies, but even in Western industrialised countries prevalence can be high within core groups of the population, such as men who have sex with men (MSM) or those of black ethnicity.2 If undetected or poorly treated, the organism can cause pelvic inflammatory disease in women, which can lead to ectopic pregnancy and infertility, and epididymitis and prostatitis in men.3
The control of gonococcal infection is facing important challenges. The ability of N gonorrhoeae to develop rapid resistance to antimicrobials is clearly at the forefront of these challenges.4 Ongoing unsafe sexual behaviour, particularly among MSM, will also limit the effectiveness of any intervention. At the same time, new diagnostic technologies could facilitate significant improvements in detection of infection, offering greater opportunities to break the chain of transmission. In this issue, we have selected papers that tackle these key themes.
As we prepare to confront the emergence of yet another wave of decreased susceptibility to current therapies for gonorrhoea, the review by Lewis5 describes the history of the amazing versatility of this bacterium to successfully overcome all our previous attempts at control by antimicrobial therapy. The gonococcus is adept at acquiring or selecting resistance determinants with the subsequent dissemination of these resistance strains. There are many lessons to be learnt as we prepare to deal with gonorrhoea as a potentially difficult or untreatable infection.
Surveillance of the emergence of, and the trends in, resistance will be vital for informing local treatment strategies and individual patient management, but the approach …
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.