Background The rapidly changing antimicrobial susceptibility of N. gonorrhoeae since the introduction of antibiotics has created challenges in gonorrhoea control. Antimicrobial resistance has regularly appeared and expanded with every release of new classes of antibiotics for gonorrhoea.

Methods The Gonococcal Antimicrobial Surveillance Programme (GASP) has been documenting the emergence and spread of antimicrobial resistance in gonorrhoea since 1992 and has informed treatment guidelines.

Results Sixty two countries participated in GASP in varying degrees including the extend of specific antimicrobials tested for resistance in 2010. There are high rates of resistance in N. gonorrhoeaeto penicillin and quinolones. There are 36 countries reporting increasing minimum inhibitory concentration (MIC) to Cefixime (≥ 0.25 μg/mL) or Ceftriaxone (≥ 0.125 μg/mL). Treatment failures to Ceftriaxone were reported in Japan, Austria, Australia, Canada, France, Norway, Slovenia, Sweden, UK and South Africa. Majority of reports is from developed countries. This is only the tip of the global health burden as surveillance data from resource-constrained settings are scarce.

Spectinomycin and azithromycin resistance are monitored in limited countries. Brunei, China, Mongolia and Russia reported decreased susceptibility to spectinomycin. Resistance to azithromycin has been identified in some European countries, US and Chile. Azithromycin resistance remains well below the 5% threshold in most countries.

Conclusions Treatment options for gonorrhoeae is dwindling. In the short term, options for treatment will include increasing dosage, using intramuscular or intravenous route and multiple doses of Ceftriaxone; use of alternative medication (e.g. gentamycin), and combination therapies. In the long term there is a need to develop newer classes of antibiotic. There is a need to ensure rational drug use and strengthen antimicrobial resistance monitoring in gonorrhoea including detection and management of treatment failure.