TY - JOUR T1 - Intractable problems require novel solutions: it's time to get serious about developing a gonorrhoea vaccine JF - Sexually Transmitted Infections JO - Sex Transm Infect SP - 561 LP - 562 DO - 10.1136/sextrans-2015-052378 VL - 92 IS - 8 AU - Evgeny A Semchenko AU - Kate L Seib Y1 - 2016/12/01 UR - http://sti.bmj.com/content/92/8/561.abstract N2 - Neisseria gonorrhoeae, the causative agent of the sexually transmitted infection gonorrhoea, is an ancient disease with biblical references.1 Despite ongoing efforts towards treatment and prevention, gonorrhoea remains a major public health problem worldwide with an estimated global incidence of 106 million cases/year,2 leading to direct and indirect costs that exceed $1 billion/year in the USA alone.3 The clinical outcomes of gonococcal infection range from asymptomatic infection to severe sequelae (reviewed in refs. 4, 5). Symptomatic infection typically presents as urethritis in males and cervicitis in females; however, mucosal infections of the rectum, pharynx and eye are also reported. In addition, asymptomatic infections occur in 50–80% of infected females and 1%–40% of infected males, which, if left undiagnosed or untreated, can lead to sequelae that include urogenital tract abscesses, pelvic inflammatory disease, adverse pregnancy outcomes, infertility and neonatal complications. Infection with N. gonorrhoeae also increases the risk of acquiring and transmitting HIV.Current attempts to control gonorrhoea include safe-sex education, as well as prompt diagnosis and antibiotic treatment of infected persons and their recent sex partners. While diagnostics (ie, nucleic acid amplification tests or bacterial culture) are highly sensitive and specific,6 education and routine screening are not sufficient to stem the spread of gonorrhoea.7 This is especially true in light of the fact that extensively drug-resistant strains with high-level resistance to the expanded-spectrum cephalosporins (ie, ceftriaxone and cefixime) have been isolated from around the world.1 Cephalosporins are the last line of defence for treating gonorrhoea, and the emergence of resistance to these drugs means that more costly and invasive treatment is now required. The current recommendations for the treatment of uncomplicated infections include the use of dual antibiotic therapy with ceftriaxone (250 mg intramuscular injection in a single dose) … ER -