The threat of untreatable gonorrhoea: implications and consequences for reproductive and sexual morbidity.

Gonorrhoea (caused by the organism Neisseria gonorrhoeae) is one of the most commonly reported sexually transmitted infections (STIs), with 106 million new cases per year globally, according to 2008 estimates by the World Health Organization (WHO). There is growing global concern about antimicrobial resistance in N. gonorrhoeae. Only third-generation cephalosporins, the last available class of antibiotics to treat this condition, currently remain as the recommended first line treatment. If gonococcal infections become untreatable, they will cause a wide range of reproductive morbidities, including pelvic inflammatory disease, infertility and neonatal blindness. Furthermore, infection with N. gonorrhoeae facilitates the transmission of HIV. Thus, there is an urgent need to contain the threat of untreatable gonorrhoea within the framework of WHO's policy package to combat antimicrobial resistance, launched in April 2011. Interventions should take cognisance of sexual networks, international travel and reproductive commodity supplies, e.g. male and female condoms. There is also an urgent need for the identification of alternative effective treatment regimens for gonococcal infections; concerted efforts to prescribe antibiotics appropriately and ensure treatment compliance; strengthened programmes for primary prevention of STIs, including the importance of protected oral sex (fellatio); enhanced screening; development of affordable and accurate screening tests; and better surveillance and monitoring of resistance.