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Neisseria gonorrhoeae (NG) has historically been very successful in developing resistance to each antimicrobial used to treat it and is now in the top three antimicrobial resistance (AMR) threats described by the Centre for Disease Control and Prevention.1 Dual therapy with ceftriaxone and azithromycin was introduced in 2011 in the attempt to delay further resistance and this is particularly important as these two antimicrobials are the last reliable options available.2 Worryingly, the emergence of multidrug-resistant gonorrhoea is quickly becoming a reality due to treatment failures, even after dual therapy in the UK and USA.3 ,4 Treatment failures mostly occur in pharyngeal infection. It is now widely accepted that pharyngeal gonorrhoea largely contributes to both the transmission of gonorrhoea and the development of AMR and is a key target area in the control efforts. Furthermore, recent studies suggests that viable gonococci can be isolated from saliva, prompting a re-evaluation of gonorrhoea transmission and control strategies.5
With this in mind, and with no effective vaccine, a new approach to the treatment and control of gonorrhoea should be considered. Antiseptics for example would be an option, perhaps targeting pharyngeal infection in the first instance as topical treatment. The notion of antiseptics for the prevention or …
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