Trends of sexually transmitted diseases and antimicrobial resistance in Neisseria gonorrhoeae.

Sexually transmitted diseases (STDs), especially HIV infection, gonococcal infection and genital chlamydial infections are increasing all over the world. UNAIDS recently reported that the number of HIV/AIDS patients had been increasing and the highest prevalence was found in African countries, followed by Caribbean, Asian and Eastern European countries. HIV infection has also been gradually increasing in Japan. In non-HIV STDs, genital chlamydial infections are increasing worldwide also. On the contrary, gonococcal infections have been decreasing in many countries except Asian countries. N. gonorrhoeae has been changing in its infecting sites. The pharynx is the most important infecting site, because gonococcal infection in the pharynx may be one of the causes of the wide spread of N. gonorrhoeae. Antimicrobial-resistant N. gonorrhoeae has wide distribution throughout the world. For example, penicillin-resistant N. gonorrhoeae is prevalent in various part of the world, and fluoroquinolone-resistant N. gonorrhoeae is prevalent mainly in Asia. In addition to penicillin, tetracycline and fluoroquinolone resistance, N. gonorrhoeae acquired resistance to almost all of the cephalosporins except for ceftriaxone and cefodizime in Japan. Although there is no resistant strain to ceftriaxone, cefodizime and spectinomycin, 1.0 g single dose of ceftriaxone is considered to be the most suitable regimen for the treatment of gonococcal infection including the pharyngeal infection, because of the 100% elimination rate of N. gonorrhoeae from the urethra, cervix and pharynx obtained in a recent study.