Review gonococcal infections

Gonorrhea, caused by Neisseria gonorrheae, is the second most commonly reported notifiable infection in the United States, with 321,849 cases reported in 2011. The epidemiology of gonococcal infections in the United States has undergone major changes in recent years, but major racial disparities remain and increases in antibiotic resistance continue to emerge and spread. The highest rates of infection are seen among adolescents and young adults, minorities, persons living in the southeastern United States and men who have sex with men. This infection is transmitted almost exclusively by sexual contact or perinatally. It primarily affects the mucous membranes of the lower genital tract and less frequently those of the rectum, oropharynx, and conjunctivae. Then, gonorrhea is a major cause of urethritis in men and cervicitis in women; the later can result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. Invasive infections including disseminated gonococcal infection, endocarditis and meningitis, are uncommon but can result in serious morbidity. Neisseria gonorrhoeae has progressively developed increasing minimum inhibitory concentrations (i.e, decreasing susceptibilities) followed by frank resistance to the antimicrobial classes most commonly used for treatment, thus progressively reducing available therapeutic options. The emerging threat of cephalosporin resistance highlights the need for continued surveillance of N. gonorrhoeae antibiotic susceptibility.