The Global Threat of Drug-Resistant Neisseria gonorrhoeae

Antibiotic resistance has emerged as one of the most significant public health challenges of the 21st century. Among the pathogens of concern, Neisseria gonorrhea, the bacterium responsible for gonorrhea, has garnered attention due to its alarming ability to evade antimicrobial treatments. Gonorrhea, one of the most common Sexually Transmitted Infections (STIs) globally, is becoming increasingly difficult to treat as N. gonorrhea develops resistance to nearly all antibiotics previously or currently used against it. This article describes into the biology of the pathogen, the mechanisms driving antibiotic resistance and the urgent need for innovative solutions. Neisseria gonorrhoeae is a gram-negative diplococcus bacterium that primarily infects the mucosal surfaces of the urethra, cervix, rectum, pharynx and conjunctiva. It is transmitted through sexual contact and in some cases, from mother to child during childbirth. Symptoms of gonorrhea can include painful urination, abnormal discharge and in women, pelvic pain. However, asymptomatic cases are common, particularly in women, complicating efforts to diagnose and control the spread of the disease. Historically, gonorrhea was easily treated with sulfonamides, penicillin and tetracycline. However, Neisseria gonorrhoeae has demonstrated a remarkable capacity for developing resistance. Mutations in genes encoding penicillinbinding proteins, ribosomal targets, or efflux pumps reduce antibiotic efficacy. Horizontal gene transfer, such as plasmidmediated acquisition of β-lactamase genes, has conferred resistance to penicillin and other β-lactam antibiotics. These transport proteins actively expel antibiotics from bacterial cells, diminishing their intracellular concentration and effectiveness. Alterations in ribosomal RNA or enzymes targeted by antibiotics hinder the drugs’ ability to bind and produce their effects. Over time, Neisseria gonorrhoeae has sequentially overcome nearly all antibiotics introduced to treat it. Fluoroquinolones, for instance, were once a mainstay but are now largely ineffective due to widespread resistance. Similarly, macrolides such as azithromycin and cephalosporins like ceftriaxone, often used in combination therapy, face declining efficacy

Author(s): Jia Feng

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