Epidemiology of antibiotic resistant Neisseria gonorrhoeae in industrialized and developing countries.

The in vitro susceptibility of Neisseria gonorrhoeae to antimicrobial drugs has been studied currently for around fifty years, and it has been convincingly demonstrated that the results of the in vitro determinations can be used as a guideline for choice of an efficient standard treatment regimen as well as for the choice of therapeutic agent in individual cases. During these past 50 years, the susceptibility of gonococci to antimicrobial drugs has undergone dramatic changes. The genetic background is chromosomal mutations as well as the acquisition of R plasmids. The selective pressure has been exerted both by use (and misuse) of antibiotics in treatment of patients and by factors in the micro-environment of the gonococcus. Review of the current spectrum of antimicrobial susceptibility patterns of N. gonorrhoeae in industrialized and developing countries and a comparison with the changing epidemiology of gonorrhoea, rises the question as to what extent antimicrobial resistance and the choice of treatment regimen influence the spread of gonorrhoea (and other sexually transmitted diseases). In the developed countries, in spite of the access to an optimal antibiotic treatment, the prevalence of gonorrhoea increased significantly in the beginning of the 1970s and remained at a high level until around 1985. Then--within the following subsequent few years--the gonorrhoea rate fell dramatically e.g. in Scandinavia. This fall coincides with the establishment of comprehensive educational programmes for the promotion of changes in sexual lifestyle. It is therefore tempting to conclude that the impact of increasing antimicrobial resistance on the changing epidemiology of gonorrhoea is minor.