The current state of antimicrobial resistant gonorrhoea

A report back on David Speers, Deborah Williamson, Cameron Buckley, David Lewis and Jana Sisnowski prese

A/Prof. David Speers kicked off the discussion of antimicrobial resistant gonorrhoea this morning as he delivered the Dr Morris Gollow’s lecture during the opening plenary.  Gonorrhoea has been steadily developing resistance to whichever antibiotic has been used to treat it since the sulfa based drugs in 1937.  David described the multiple mechanisms that Neisseria gonorrhoeae uses to incorporate antimicrobial resistance and while it raises serious concerns about our ability to treat this infection in the future, one can’t help but admire its innovation and resilience!  ​

This was a fitting introduction to Symposium 2, which delved deeper into the issues of antimicrobial resistance.  This session highlighted the value of looking at both laboratory and epidemiological and behavioural data to understand the trends in antimicrobial resistance.  Real time testing for antimicrobial resistance is required to guide treatment.  There continues to be sporadic isolates which are resistant to ceftriaxone.  However increasingly, low level and high level azithromycin resistance is being reported.  This has led to BASHH removing azithromycin from their treatment guidelines, and the Australian STI Management Guidelines increasing the dosage for pharyngeal infection.  Prof. David Lewis outlined the rationale for this treatment alteration which include retaining dual therapy to reduce further resistance; improving cure rates as the MICs for azithromycin approach clinical break points; and the poor drug uptake in the pharynx.  While truly understanding the current situation with antimicrobial resistant gonorrhoea in Australia is somewhat limited by the increasing reliance on PCR testing and the absence of culture, it is clear that tackling this issue must remain a focus.  Reducing gonorrhoea incidence is of course the single most important action. Molecular Surveillance and clear guidelines are crucial. approaches may allow us to use older drugs, like ciprofloxacin again, while there are some new pharmaceutical agents in the pipeline with Zoliflodacin and Gepotidacin moving into Phase 3 trials.


Author bio: Sharon is the Clinical Nurse Consultant for HIV & Sexual Health at St George Hospital, Sydney, NSW.