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Chapter 12 : Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century

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Abstract:

The sexually transmitted infection gonorrhea is a very old malady that can be traced to ancient Chinese, Egyptian, Roman, and Greek literature as well as in the Old Testament of the Bible (Leviticus 15:1–3). (gonococcus), the obligate human pathogen and etiological agent of gonorrhea, is primarily transmitted from an infected individual by direct human-to-human contact between the mucosal membranes of the urogenital tract, anal canal, and the oropharynx, usually during sexual activities. Neonates can be infected during passage through the birth canal if the mother has urogenital gonorrhea. After transmission, causes urethritis in males and cervicitis in females. Relatively few males (≤10%) but a large proportion of females (≥50%) can have an asymptomatic urogenital infection. Rectal and pharyngeal gonorrhea is commonly asymptomatic in both genders. These infections are most frequently identified in men who have sex with men (MSM), but dependent on sexual practice, they can be encountered in both genders in many settings. Urogenital infections, if untreated, might ascend to the upper genital tract and result in severe reproductive complications (mostly, but not only, in females), such as pelvic inflammatory disease in women and epididymitis (rare) in men, that can result in infertility or, for women, even loss of life through ectopic pregnancy. Gonococcal infections also facilitate the transmission and acquisition of HIV ( ). may also cause conjunctivitis, mostly in neonates (ophthalmia neonatorum) infected by their mothers during delivery but also in adults. Conjunctivitis may, if untreated, result in blindness. Disseminated gonococcal infection is an uncommon complication of gonococcal infection; although it is rare, this can lead to, for example, arthritis, meningitis, and endocarditis ( ).

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
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Figure 1

Gonococcal Isolate Surveillance Project (GISP) sentinel sites and regional laboratories in 2015. Courtesy of Centers for Diseases Control and Prevention (http://www.cdc.gov/std/gisp/gisp-map.htm).

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
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Image of Figure 2
Figure 2

Gonococcal Isolate Surveillance Project (GISP) antimicrobial testing panel with Clinical and Laboratory Standards Institute (CLSI) breakpoints in 2014. Gray = sensitive; yellow = Intermediate; orange/red = resistant.

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
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Image of Figure 3
Figure 3

Prevalence of resistance in in the U.S. Gonococcal Isolate Surveillance Project (GISP) from 2000 to 2014. R, resistance; RS, reduced susceptibility.

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
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Image of Figure 4
Figure 4

Antimicrobials used to treat gonorrhea in the United States from 1988 to 2013. Courtesy of Centers for Disease Control and Prevention (http://www.cdc.gov/std/gisp/gisp2013.htm).

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
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Tables

Generic image for table
TABLE 1

Main antimicrobial resistance determinants in for previously and currently recommended antimicrobials for treatment of gonorrhea (adapted from reference )

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
Generic image for table
TABLE 2

Recommended treatments for uncomplicated infections of the urethra, cervix, rectum, and pharynx in adults and youth in the United States, Canada, Australia, and Europe

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015
Generic image for table
TABLE 3

Key components of the WHO global action plan to control the spread and impact of antimicrobial resistance in

Citation: Unemo M, del Rio C, Shafer W. 2016. Antimicrobial Resistance Expressed by : A Major Global Public Health Problem in the 21st Century, p 213-237. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0009-2015

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