Choosing New Therapies for Gonorrhoea: We Need to Consider the Impact on the Pan-Neisseria Genome. A Viewpoint

Abstract

The development of new gonorrhoea treatment guidelines typically considers the resistance-inducing effect of the treatment only on <i>Neisseria gonorrhoeae</i>. Antimicrobial resistance in <i>N. gonorrhoeae</i> has, however, frequently first emerged in commensal <i>Neisseria</i> species and then been passed on to <i>N. gonorrhoeae</i> via transformation. This creates the rationale for considering the effect of gonococcal therapies on resistance in commensal <i>Neisseria</i>. We illustrate the benefits of this pan-<i>Neisseria</i> strategy by evaluating three contemporary treatment options for <i>N. gonorrhoeae</i>-ceftriaxone plus azithromycin, monotherapy with ceftriaxone and zoliflodacin.