SEXUALLY TRANSMITTED DISEASES: Edited by Karen RogstadGlobal resistance of Neisseria gonorrhoeae: when theory becomes realityLewis, David A.a,b,cAuthor Information aCentre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service bDepartment of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg cDivision of Medical Microbiology, University of Cape Town, Cape Town, South Africa Correspondence to Professor David A. Lewis, FRCP(UK), PhD, Centre for HIV and STIs, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham 2131, South Africa. Tel: +27 11 555 0468; e-mail: firstname.lastname@example.org Current Opinion in Infectious Diseases: February 2014 - Volume 27 - Issue 1 - p 62-67 doi: 10.1097/QCO.0000000000000025 Buy Metrics Abstract Purpose of review Neisseria gonorrhoeae has demonstrated a remarkable genetic capacity to acquire antimicrobial resistance (AMR) determinants. This review focuses on the recent developments in respect of third generation extended spectrum cephalosporin (ESC)-resistant gonorrhoea and the search for future treatment options. Recent findings The estimated incidence of new gonorrhoea cases is increasing, and the antimicrobial resistance profile of N. gonorrhoeae is worsening. The most significant recent finding has been the emergence of extensively drug-resistant (XDR) N. gonorrhoeae characterized by very high ceftriaxone minimum inhibitory concentrations. A national switch from cefixime to high-dose ceftriaxone as first-line antigonococcal therapy in England and Wales, as well as parts of Japan, has been accompanied by a reduction in the prevalence of oral ESC-resistant gonococci. Azithromycin given in combination with either gentamicin or gemifloxacin has been shown to be an effective alternative antigonococcal therapy. Both ertapenem and solithromycin have good in-vitro activity against ESC-resistant N. gonorrhoeae strains. Summary Current strategies to control gonococcal AMR should focus on the use of higher doses of ceftriaxone given as part of dual therapy and further evaluation of alternative drug combinations. The emergence of XDR gonorrhoea argues for enhanced efforts to develop novel antimicrobial agents and a gonococcal vaccine. © 2014 Lippincott Williams & Wilkins, Inc.