Sophie Ross, Nicolas Pinto-Sander, Collins Iwuji , 2025-05-19 12:46:00
- Sophie Ross, specialist registrar genitourinary medicine1,
- Nicolas Pinto-Sander, consultant sexual health and HIV medicine1,
- Collins Iwuji, honorary consultant physician, professor of global health and HIV medicine12
- 1University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- 2Department of global health and infection, Brighton and Sussex Medical School, University of Sussex, Brighton
- Correspondence to: S Ross sophie.ross5{at}nhs.net
What you need to know
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Increasing incidence of gonorrhoea is likely to lead to more complicated and systemic presentations such as pelvic inflammatory disease, septic arthritis, and neonatal infection
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Increasing antimicrobial resistance is limiting treatment options for gonorrhoea, and management of suspected and confirmed cases must seek to minimise the development of further resistance. Gaining specimens for culture and sensitivity to guide treatment and monitor resistance patterns prior to treatment is crucial
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Gonorrhoea disproportionately affects marginalised groups, such as men who have sex with men and some ethnic minorities, and control will not be achieved without dismantling systemic barriers to good sexual health
Gonorrhoea is of increasing concern for global sexual health. Continued stigmatisation of sexual health, particularly for those in marginalised communities, contributes to increasing incidence, greater complexity of cases, and the rise of multidrug resistant strains.1 Antimicrobial resistance (AMR) limits treatment options. Condoms are highly effective at preventing transmission, but their use has been declining across several groups, even prior to the arrival of HIV pre-exposure prevention.23 Here, we consider the challenges of diagnosis and holistic management of gonorrhoea in a global context as well as current and future treatment strategies.
What is the scale of the problem?
An estimated 82.4 million new gonorrhoea infections occurred globally in 2020, making gonorrhoea the second most commonly diagnosed bacterial sexually transmitted infection (STI) after chlamydia.4 Incidence of reported cases is highest in the World Health Organization (WHO) African region (adult incidence 36 per 1000 person-years) and the Western Pacific region (adult incidence 24 per 1000 person-years).4 Most countries in the regions that bear the highest burden of infection also lack adequate laboratory facilities and other infrastructure needed for effective diagnosis and management.4 International targets for reduction of gonorrhoea incidence as part of an elimination strategy have not been met1 and data from most high income …
