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      Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future.

      1 , 2
      Clinical microbiology reviews
      American Society for Microbiology

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          Abstract

          Neisseria gonorrhoeae is evolving into a superbug with resistance to previously and currently recommended antimicrobials for treatment of gonorrhea, which is a major public health concern globally. Given the global nature of gonorrhea, the high rate of usage of antimicrobials, suboptimal control and monitoring of antimicrobial resistance (AMR) and treatment failures, slow update of treatment guidelines in most geographical settings, and the extraordinary capacity of the gonococci to develop and retain AMR, it is likely that the global problem of gonococcal AMR will worsen in the foreseeable future and that the severe complications of gonorrhea will emerge as a silent epidemic. By understanding the evolution, emergence, and spread of AMR in N. gonorrhoeae, including its molecular and phenotypic mechanisms, resistance to antimicrobials used clinically can be anticipated, future methods for genetic testing for AMR might permit region-specific and tailor-made antimicrobial therapy, and the design of novel antimicrobials to circumvent the resistance problems can be undertaken more rationally. This review focuses on the history and evolution of gonorrhea treatment regimens and emerging resistance to them, on genetic and phenotypic determinants of gonococcal resistance to previously and currently recommended antimicrobials, including biological costs or benefits; and on crucial actions and future advances necessary to detect and treat resistant gonococcal strains and, ultimately, retain gonorrhea as a treatable infection.

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          Author and article information

          Journal
          Clin Microbiol Rev
          Clinical microbiology reviews
          American Society for Microbiology
          1098-6618
          0893-8512
          Jul 2014
          : 27
          : 3
          Affiliations
          [1 ] WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
          [2 ] Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA Laboratories of Bacterial Pathogenesis, Veterans Affairs Medical Center, Decatur, Georgia, USA wshafer@emory.edu.
          Article
          27/3/587
          10.1128/CMR.00010-14
          4135894
          24982323
          d4a85c8c-075d-47e2-b18f-dcf96989cf20
          Copyright © 2014, American Society for Microbiology. All Rights Reserved.
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