The ticking time bomb: escalating antibiotic resistance in Neisseria gonorrhoeae is a public health disaster in waiting

J Antimicrob Chemother. 2012 Sep;67(9):2059-61. doi: 10.1093/jac/dks188. Epub 2012 May 17.


From a once easily treatable infection, gonorrhoea has evolved into a challenging disease, which in future may become untreatable in certain circumstances. International spread of extensively drug-resistant gonococci would have severe public health implications. It seems clear that under the current treatment pressure from extended-spectrum cephalosporins, and owing to Neisseria gonorrhoeae's remarkable evolutionary adaptability, further rise of ceftriaxone-resistant strains around the world is inevitable. Simply increasing the doses of extended-spectrum cephalosporins will likely prove ineffective in the long run, and has been a lesson learnt for all single-agent therapies used for gonorrhoea to date. We recommend that dual therapy, especially those consisting of extended-spectrum cephalosporins and azithromycin, be adopted more widely and complemented by strengthening of antimicrobial resistance surveillance. Unless there is urgent action at international and local levels to combat the problem of N. gonorrhoeae antimicrobial resistance, we are in for gloomy times ahead in terms of gonorrhoea disease and control.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / pharmacology
  • Azithromycin / therapeutic use
  • Cephalosporins / pharmacology*
  • Cephalosporins / therapeutic use
  • Gonorrhea / drug therapy
  • Gonorrhea / epidemiology*
  • Gonorrhea / microbiology*
  • Humans
  • Neisseria gonorrhoeae / drug effects*
  • Neisseria gonorrhoeae / isolation & purification
  • Public Health / trends*
  • beta-Lactam Resistance*


  • Anti-Bacterial Agents
  • Cephalosporins
  • Azithromycin