Pathogenesis And Antibiotic Resistance of Neisseria Gonorrhoeae: A Review Article
Main Article Content
Abstract
Neisseria gonorrhoeae is a major public health problem. Rising prevalence and increasing antibiotic resistance in this organism make a growing concern. Timely treatment and management of infections depend on better understanding its microbiological features and effective diagnostic methodologies. Neisseria gonorrhoeae, the etiologic agent of gonorrhea, is an important sexually transmitted infection (STI). The pathophysiology of infections due to N. gonorrhoeae describes interaction of the bacterium with host defense mechanisms that result in various clinical manifestations. Neisseria gonorrhoeae has almost continuously over the last decades been a significant public health challenge increasing infection rates and rising antibiotic resistance. Hence updated protocols for therapy as recently guidelines recommended based upon research findings. This paper shall carry an integrative appraisal of recent works related to the microbiological traits of N. gonorrhoeae, the competence of current diagnostic measures, and the menace brought by antimicrobial resistance. It carries an integrative appraisal of existing research findings on the pathogenesis of N. gonorrhoeae with a focus on its infection mechanisms, antimicrobial resistance, and implications for treatment. This paper shall carry another integrative appraisal of existing perceptions concerning the antimicrobial treatment of infections caused by N. gonorrhoeae with a focus on challenges from patterns of resistance, adequacy levels of existing regimens, and possible future directions in research.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Agarwal, A.., Rana, Mohit., Qiu, Emily., Albunni, Hashem., Bui, A.., & Henkel, R.. (2018). Role of oxidative stress, infection and inflammation in male infertility. Andrologia , 50 . http://doi.org/10.1111/and.13126
Aghapour, Zahra., Gholizadeh, P.., Ganbarov, K.., Bialvaei, Abed Zahedi., Mahmood, S. S.., Tanomand, A.., Yousefi, M.., Asgharzadeh, M.., Yousefi, B.., & Kafil, H.. (2019). Molecular mechanisms related to colistin resistance in Enterobacteriaceae. Infection and Drug Resistance , 12 , 965 - 975 . http://doi.org/10.2147/IDR.S199844
Allen, V.., Mitterni, L.., Seah, C.., Rebbapragada, A.., Martin, I.., Lee, Colin., Siebert, Heather., Towns, L.., Melano, R.., & Low, D.. (2013). Neisseria gonorrhoeae treatment failure and susceptibility to cefixime in Toronto, Canada.. JAMA , 309 2 , 163-70 . http://doi.org/10.1001/jama.2012.176575
Asif, M.., Alvi, Iqbal Ahmad., & Réhman, S.. (2018). Insight into Acinetobacter baumannii: pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities. Infection and Drug Resistance , 11 , 1249 - 1260 . http://doi.org/10.2147/IDR.S166750
Chan, P.., Robinette, A.., Montgomery, M.., Almonte, Alexi A., Cu-Uvin, S.., Lonks, J.., Chapin, K.., Kojic, E.., & Hardy, E.. (2016). Extragenital Infections Caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A Review of the Literature. Infectious Diseases in Obstetrics and Gynecology , 2016 . http://doi.org/10.1155/2016/5758387
Chisholm, S.., Mouton, J.., Lewis, D.., Nichols, T.., Ison, C.., & Livermore, D.. (2010). Cephalosporin MIC creep among gonococci: time for a pharmacodynamic rethink?. The Journal of antimicrobial chemotherapy , 65 10 , 2141-8 . http://doi.org/10.1093/jac/dkq289
Chisholm, S.., Wilson, Janet D.., Alexander, S.., Tripodo, Francesco., Al-Shahib, Ali., Schaefer, Ulf., Lythgow, Kieren T.., & Fifer, H.. (2015). An outbreak of high-level azithromycin resistant Neisseria gonorrhoeae in England. Sexually Transmitted Infections , 92 , 365 - 367 . http://doi.org/10.1136/sextrans-2015-052312
Cortina, S. Herbst de., Bristow, C.., Davey, D. J. Joseph., & Klausner, J.. (2016). A Systematic Review of Point of Care Testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Infectious Diseases in Obstetrics and Gynecology , 2016 . http://doi.org/10.1155/2016/4386127
Cyr, S. S. St.., Barbee, L.., Workowski, K.., Bachmann, L.., Pham, C.., Schlanger, Karen., Torrone, Elizabeth A., Weinstock, H.., Kersh, E.., & Thorpe, Phoebe G.. (2020). Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020. Morbidity and Mortality Weekly Report , 69 , 1911 - 1916 . http://doi.org/10.15585/mmwr.mm6950a6
Demczuk, W.., Martin, I.., Peterson, S.., Bharat, A.., Domselaar, G. Van., Graham, M.., Lefebvre, B.., Allen, V.., Hoang, L.., Tyrrell, G.., Horsman, G.., Wylie, J.., Haldane, D.., Archibald, C.., Wong, T.., Unemo, M.., & Mulvey, M.. (2016). Genomic Epidemiology and Molecular Resistance Mechanisms of Azithromycin-Resistant Neisseria gonorrhoeae in Canada from 1997 to 2014. Journal of Clinical Microbiology , 54 , 1304 - 1313 . http://doi.org/10.1128/JCM.03195-15
Detels, R.., Green, Annette M.., Klausner, J.., Katzenstein, D.., Gaydos, C.., Handsfield, H.., Pequegnat, W.., Mayer, K.., Hartwell, T.., & Quinn, T.. (2011). The Incidence and Correlates of Symptomatic and Asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Selected Populations in Five Countries. Sexually Transmitted Diseases , 38 , 503-509 . http://doi.org/10.1097/OLQ.0b013e318206c288
Edwards, J. L., & Apicella, M. A. (2004). The molecular mechanisms used by Neisseria gonorrhoeae to initiate infection differ between men and women. Clinical Microbiology Reviews, 17(4), 965–981. https://doi.org/10.1128/CMR.17.4.965-981.2004
Eyre, D.., Silva, Dilrini De., Cole, K.., Peters, Joanna., Cole, M.., Grad, Y.., Demczuk, W.., Martin, I.., Mulvey, M.., Crook, D.., Walker, A.., Peto, T.., & Paul, J.. (2017). WGS to predict antibiotic MICs for Neisseria gonorrhoeae. Journal of Antimicrobial Chemotherapy , 72 , 1937 - 1947 . http://doi.org/10.1093/jac/dkx067
Eyre, D.., Town, K.., Street, T.., Barker, L.., Sanderson, N.., Cole, M.., Mohammed, H.., Pitt, R.., Gobin, M.., Irish, C.., Gardiner, D.., Sedgwick, J.., Beck, Charles R., Saunders, J.., Turbitt, D.., Cook, Clare., Phin, N.., Nathan, B.., Horner, P.., & Fifer, H.. (2019). Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018. Eurosurveillance , 24 . http://doi.org/10.2807/1560-7917.ES.2019.24.10.1900147
Gaydos, C.., Pol, B. Van Der., Jett-Goheen, M.., Barnes, M.., Quinn, N.., Clark, Carey., Daniel, Grace., Dixon, P.., & Hook, E.. (2013). Performance of the Cepheid CT/NG Xpert Rapid PCR Test for Detection of Chlamydia trachomatis and Neisseria gonorrhoeae. Journal of Clinical Microbiology , 51 , 1666 - 1672 . http://doi.org/10.1128/JCM.03461-12
Grad, Y.., Harris, S.., Kirkcaldy, R.., Green, Anna G.., Marks, D.., Bentley, S.., Trees, D.., & Lipsitch, M.. (2016). Genomic Epidemiology of Gonococcal Resistance to Extended-Spectrum Cephalosporins, Macrolides, and Fluoroquinolones in the United States, 2000–2013. The Journal of Infectious Diseases , 214 , 1579 - 1587 . http://doi.org/10.1093/infdis/jiw420
Kirkcaldy, R.., Weinstock, H.., Moore, P.., Philip, S.., Wiesenfeld, H.., Papp, J.., Kerndt, P.., Johnson, S.., Ghanem, K.., & Hook, E.. (2014). The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America , 59 8 , 1083-91 . http://doi.org/10.1093/cid/ciu521
Kirkcaldy, R.., Workowski, K.., Kidd, S.., Weinstock, H.., Papp, J.., Trees, D.., Peterman, T.., & Bolan, G.. (2012). Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections.. MMWR. Morbidity and mortality weekly report , 61 31 , 590-4 . http://doi.org/10.1001/2012.jama.11292
Lee, Chang-Ro., Lee, Jung Hun., Park, Moonhee., Park, Kwang Seung., Bae, I. K.., Kim, Young Bae., Cha, C.., Jeong, B.., & Lee, S.. (2017). Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Frontiers in Cellular and Infection Microbiology , 7 . http://doi.org/10.3389/fcimb.2017.00055
Lewis, D. A. (2013). The role of core groups in the emergence and dissemination of antimicrobial-resistant N. gonorrhoeae. Sexually Transmitted Infections, 89(Suppl 4), iv47–iv51. https://doi.org/10.1136/sextrans-2013-051061
Liu, Y., Egilmez, N. K., Russell, M. W. (2018). Enhancement of adaptive immunity against Neisseria gonorrhoeae by local intravaginal administration of interleukin 12 encapsulated in biodegradable microspheres. Infection and Immunity, 86(5), e00776-17. https://doi.org/10.1128/IAI.00776-17
Muscogiuri, G.., Cantone, E.., Cassarano, Sara., Tuccinardi, D.., Barrea, L.., Savastano, S.., Colao, A.., & nutrition, Education Research and Assessment group on behalf of the Obesity Programs of. (2019). Gut microbiota: a new path to treat obesity. International Journal of Obesity Supplements , 1-10 . http://doi.org/10.1038/S41367-019-0011-7
Nguyen, G. T.., Green, Erin R., & Mecsas, J.. (2017). Neutrophils to the ROScue: Mechanisms of NADPH Oxidase Activation and Bacterial Resistance. Frontiers in Cellular and Infection Microbiology , 7 . http://doi.org/10.3389/fcimb.2017.00373
Quillin, Sarah J., & Seifert, S.. (2018). Neisseria gonorrhoeae host adaptation and pathogenesis. Nature Reviews Microbiology , 16 , 226-240 . http://doi.org/10.1038/nrmicro.2017.169
Rice, P.., Shafer, W.., Ram, S.., & Jerse, A.. (2017). Neisseria gonorrhoeae: Drug Resistance, Mouse Models, and Vaccine Development.. Annual review of microbiology , 71 , 665-686 . http://doi.org/10.1146/annurev-micro-090816-093530
Tamarelle, Jeanne., Thiébaut, Anne C. M.., Barbeyrac, B.., Bébéar, C.., Ravel, J.., & Delarocque-Astagneau, E.. (2019). The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis.. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases , 25 1 , 35-47 . http://doi.org/10.1016/j.cmi.2018.04.019
Taylor, S.., Marrazzo, J.., Batteiger, B.., Hook, E.., Seña, A.., Long, Jill., Wierzbicki, Michael R.., Kwak, Hannah., Johnson, S.., Lawrence, K.., & Mueller, John D.. (2018). Single‐Dose Zoliflodacin (ETX0914) for Treatment of Urogenital Gonorrhea. The New England Journal of Medicine , 379 , 1835–1845 . http://doi.org/10.1056/NEJMoa1706988
Unemo, M., & Shafer, W. M. (2014). Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Annals of the New York Academy of Sciences, 1323(1), 97–116. https://doi.org/10.1111/nyas.12394
Unemo, M.., & Shafer, W.. (2011). Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Annals of the New York Academy of Sciences , 1230 . http://doi.org/10.1111/j.1749-6632.2011.06215.x
Unemo, M.., & Shafer, W.. (2014). Antimicrobial Resistance in Neisseria gonorrhoeae in the 21st Century: Past, Evolution, and Future. Clinical Microbiology Reviews , 27 , 587 - 613 . http://doi.org/10.1128/CMR.00010-14
Unemo, M.., Rio, C. del., & Shafer, W.. (2016). Antimicrobial Resistance Expressed by Neisseria gonorrhoeae: A Major Global Public Health Problem in the 21st Century. Microbiology Spectrum , 4 . http://doi.org/10.1128/microbiolspec.ei10-0009-2015
Villar, J.., Blanco, J.., Añón, J.., Santos-Bouza, Antonio., Blanch, L.., Ambrós, A.., Gandía, F.., Carriedo, D.., Mosteiro, F.., Basaldúa, Santiago., Fernández, R. L.., Kacmarek, R.., & Network, on behalf of the Alien. (2011). The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Medicine , 37 , 1932-1941 . http://doi.org/10.1007/s00134-011-2380-4
Wi, T., Lahra, M. M., Ndowa, F., Bala, M., Dillon, J. R., Ramon-Pardo, P., ... & Unemo, M. (2017). Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Medicine, 14(7), e1002344. https://doi.org/10.1371/journal.pmed.1002344
Workowski, K.., & Bolan, Gail A. (2015). Sexually transmitted diseases treatment guidelines, 2015.. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports , 64 RR-03 , 1-137 . http://doi.org/10.18370/2309-4117.2015.24.51-56
Workowski, K.., Bachmann, L.., Chan, P.., Johnston, C.., Muzny, C.., Park, Ina U.., Reno, H.., Zenilman, J.., & Bolan, G.. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports , 70 , 1 - 187 . http://doi.org/10.15585/mmwr.rr7004a1
World Health Organization (WHO). (2021). Gonococcal antimicrobial susceptibility surveillance in the Western Pacific and South-East Asia Regions, 2017–2018. https://www.who.int/publications/i/item/9789240022037
Zughaier, S. M., Kandler, J. L., & Shafer, W. M. (2015). Neisseria gonorrhoeae modulates iron-limiting innate immune defenses in macrophages. PLoS ONE, 10(3), e0123021. https://doi.org/10.1371/journal.pone.0123021