The continuing evolution of antibiotic resistance in Neisseria gonorrhoeae: past, present and future threats to effective treatment.

The article focuses on the global public health challenge posed by Neisseria gonorrhoeae, the bacterium causing gonorrhoea, particularly its evolving resistance to multiple antibiotics over the past eight decades. It details the historical and current patterns of resistance to key antibiotic classes—including sulphonamides, penicillin, tetracyclines, quinolones, azithromycin, and cephalosporins—and highlights the impact of this resistance on treatment guidelines, which have had to be frequently updated. The article emphasizes the need for a multidisciplinary global approach involving affordable diagnostics, robust antimicrobial resistance surveillance, antimicrobial stewardship, and the development of new antibiotics such as zoliflodacin and gepotidacin. It also discusses challenges in optimizing treatment strategies to delay resistance emergence and the importance of international cooperation to maintain gonorrhoea as a treatable infection.