Exceedingly high levels of tetracycline resistance in Neisseria gonorrhoeae in eight WHO Enhanced Gonococcal Antimicrobial Surveillance Programme countries in three WHO regions, 2021–2024—doxycycline post-exposure prophylaxis will unlikely impact gonorrhoea burdens

This article focuses on the prevalence of tetracycline resistance in Neisseria gonorrhoeae isolates from eight countries participating in the World Health Organization Enhanced Gonococcal Antimicrobial Surveillance Programme (WHO EGASP) between 2021 and 2024. The study found exceedingly high levels of tetracycline resistance—ranging from approximately 80% to over 90% depending on the clinical breakpoint used—across countries in the WHO Western Pacific, South-East Asian, and African regions. These findings suggest that doxycycline post-exposure prophylaxis (doxycycline-PEP) is unlikely to significantly reduce gonorrhoea incidence in these settings and may contribute to the selection of additional tetracycline-resistant and multidrug-resistant gonococcal strains. While doxycycline-PEP has demonstrated short-term effectiveness in reducing syphilis and chlamydia cases among men who have sex with men with frequent bacterial STIs, the potential risks related to antimicrobial resistance and impacts on microbiomes underscore the need for cautious implementation, ongoing surveillance, and informed clinical guidance.