Antimicrobial-resistant Neisseria gonorrhoeae: A threat to public health

Neisseria gonorrhoeae is the second most common sexually transmitted infection and has attracted attention due to its low therapeutic efficacy. However, over time the gonococcus has developed decreased susceptibility to antimicrobials, which has resulted in frank resistance to the classes, reducing drug options. The aim of this study is to discuss gonococcal resistance to antibiotics in order to stimulate debate on the subject. To this end, 32 articles were selected from the PubMed and Scielo platforms. Gonorrhea affects the mucous membranes of the lower genital tract, rectum, oropharynx and conjunctiva. Its clinical picture varies from the absence of symptoms to episodes of salpingitis, epididymitis and neonatal conjunctivitis. This leads to unquestionable social impacts. The Ministry of Health recommends ceftriaxone and azithromycin as treatment. The use of two antimicrobial classes is based on the fact that they have different mechanisms of action, in order to delay the development of resistance. The gonococcus has been described as highly susceptible to many drug classes, the first being sulfonamides, but the bacterium has shown the ability to develop resistance. This has happened with other antibiotics, due to the fact that the gonococcus has the ability to alter its genetic material with mutations that allow it to adapt and transform its life cycle. In Brazil, the first strain of penicillin-resistant gonococcus was isolated in 1985. Over the years, resistance has spread to other antimicrobials, such as tetracycline, amphenicillins, macrolides and quinolones. Between 2015 and 2016, the rate of resistance to ciprofloxacin in the country was 55.6%. It is estimated that 0.1% of the 80 million cases of gonococcus reported each year are tested for antimicrobial resistance. Finally, it is believed that further research should focus on the mutagenic capacity of the bacteria to evade the mechanisms of action of antibiotics, and that it is not feasible to expand drug spectra or associate drugs, as these would only be temporary alternatives.