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The Gonococcus fights back: is this time a knock out?
  1. David A Lewis1,2,3
  1. 1STI Reference Centre, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
  2. 2Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Professor David A Lewis, STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4, Sandringham 2131, South Africa; davidl{at}


Since the introduction of antibiotics in the 1930s, Neisseria gonorrhoeae has exhibited a remarkable ability to acquire novel genetic resistance determinants. Initially, sulphonamides were replaced by penicillin, while tetracyclines were prescribed for penicillin-allergic patients. With the advent of penicillinase-producing gonococci, spectinomycin was only briefly useful as alternative treatment and plasmid-mediated tetracycline resistance spread rapidly from the mid-1980s onwards. The fluoroquinolones followed but chromosomally mediated resistance appeared after only a decade of use. Seventy years on, we now face a global public health challenge of immense significance—the emergence of resistance to cephalosporins. With lack of investment in the search for new anti-gonococcal antimicrobial agents or vaccine research, the global spread of multiresistant gonococci can be seen. The impact of untreatable gonorrhoea on HIV transmission could be enormous in high-prevalence countries. This threat comes at a time when many national STI control programmes are weak. To delay the emergence of extensively drug-resistant gonorrhoea, public health systems require strengthening and novel strategies need implementing to enhance the therapeutic lifespan of the few antimicrobial agents that we have left.

  • Neisseria gonorrhoeae
  • antibiotic resistance
  • penicillin
  • quinolone
  • cephalosporin
  • ciprofloxacin

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.