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Antimicrobial treatment and resistance in sexually transmitted bacterial infections

Nature Reviews Microbiology (2024)Cite this article

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Abstract

Sexually transmitted infections (STIs) have been part of human life since ancient times, and their symptoms affect quality of life, and sequelae are common. Socioeconomic and behavioural trends affect the prevalence of STIs, but the discovery of antimicrobials gave hope for treatment, control of the spread of infection and lower rates of sequelae. This has to some extent been achieved, but increasing antimicrobial resistance and increasing transmission in high-risk sexual networks threaten this progress. For Neisseria gonorrhoeae, the only remaining first-line treatment (with ceftriaxone) is at risk of becoming ineffective, and for Mycoplasma genitalium, for which fewer alternative antimicrobial classes are available, incurable infections have already been reported. For Chlamydia trachomatis, in vitro resistance to first-line tetracyclines and macrolides has never been confirmed despite decades of treatment of this highly prevalent STI. Similarly, Treponema pallidum, the cause of syphilis, has remained susceptible to first-line penicillin.

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Fig. 1: Global maps of the Mycoplasma genitalium antimicrobial resistance rates.
Fig. 2: Global maps of the Neisseria gonorrhoeae ceftriaxone and azithromycin resistance rates.

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Acknowledgements

The authors are very grateful to the WHO and the WHO Global Gonococcal Antimicrobial Surveillance Program (GASP), especially T. Wi, M. Escher and I. Maatouk, for sharing antimicrobial resistance data for N. gonorrhoeae.

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  1. Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark

    Jorgen S. Jensen

  2. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

    Magnus Unemo

  3. Institute for Global Health, University College London, London, UK

    Magnus Unemo

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Jensen, J.S., Unemo, M. Antimicrobial treatment and resistance in sexually transmitted bacterial infections. Nat Rev Microbiol (2024). https://doi.org/10.1038/s41579-024-01023-3

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