TY - JOUR T1 - The Gonococcus fights back: is this time a knock out? JF - Sexually Transmitted Infections JO - Sex Transm Infect SP - 415 LP - 421 DO - 10.1136/sti.2010.042648 VL - 86 IS - 6 AU - David A Lewis Y1 - 2010/11/01 UR - http://sti.bmj.com/content/86/6/415.abstract N2 - 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. ER -