Introduction

In 1929, Alexander Fleming published an article about a substance he called penicillin which had been produced from a strain of penicillium fungus species.1 This discovery was to change the history of medicine in relation to bacterial infections. The treatment of gonorrhoea, a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae, was revolutionised by the introduction of penicillin when sulfonamides were no longer effective by 1945. Penicillins prevailed as the main treatment option of gonorrhoea for the next 40 years! However, by the mid-1980s, penicillins and other antimicrobial agents, such as the tetracyclines and macrolides, were no longer as effective in curing gonococcal infections because of both plasmid and chromosomally-mediated resistance mechanisms in N gonorrhoeae. Spectinomycin and, subsequently, fluoroquinolones, such as ciprofloxacin and ofloxacin, looked like the saviours of the day, but short-lived as resistance quickly developed and, by mid-to-late 1990s, virtually all regions of the world were gradually abandoning their use as recommended treatment for gonococcal infections.2–5 This situation heralded the introduction, on almost a global level, of the extended-spectrum cephalosporins, such as ceftriaxone and cefixime (or other equivalent formulations).6 ,7

The control of gonococcal infections, as an STI, relies on primary prevention and the availability of accessible, effective antimicrobial agents. What is being observed at the moment from one region of the world to another, as some of the regional papers in this supplement highlight, is the emergence of antimicrobial resistance in N gonorrhoeae to the extended-spectrum cephalosporins as evidenced by observations of increasing gonococcal minimum inhibitory concentrations of both ceftriaxone and cefixime,8 and treatment failures in some patients treated with these agents.9–11 Of major concern is that this situation is happening when there are no new therapeutic agents in the pipeline for …