Gonococcal infections.

Gonorrhea may be the most extensively studied infection of the past 20 years. The gonorrhea epidemic in the United States began in the early 1960s and peaked in 1975. Ironically, since 1976 the declining overall incidence has been offset by the advent of plasmid-mediated beta-lactamase production by Neisseria gonorrhoeae and by a growing problem with outbreaks due to strains with chromosomally mediated penicillin and tetracycline resistance. This new antimicrobial resistance, coupled with the frequency of concurrent chlamydial infection in developed countries and concurrent syphilis in some developing countries, has created a need for new approaches to gonorrhea therapy. With the introduction of certain new antimicrobial agents, highly effective forms of therapy are again available. New approaches to rapid diagnosis are also becoming available, but require critical appraisal. Unfortunately, in most of the world's population, gonorrhea remains epidemic, diagnosis of gonorrhea in women is extremely difficult, and highly effective antimicrobial agents are no longer affordable. Thus, vaccine development remains an extremely important goal. Although no candidate gonococcal vaccine currently holds high promise, the increasing understanding of the biology of the gonococcus and the pathogenesis of gonorrhea will serve to focus future research on vaccine development.