Introductory address: resistance to antimicrobial agents. What next for Neisseria gonorrhoeae?

The development of gonococcal resistance to antimicrobial agents, attributable to either chromosomal mutation or to the acquisition of plasmid-mediated penicillin resistance, has been a significant trend of the past several decades. Decreased susceptibility of Neisseria gonorrhoeae to therapeutically effective antibiotics, such as spectinomycin and some cephalosporins, has also been reported. Thus, the monitoring of antimicrobial susceptibility is critical to determine whether particular treatment regimens will be effective in a given geographic area. The association between auxotype and susceptibility to antimicrobial agents has often been overlooked as a rationale for changes in susceptibility patterns. For example, the dramatic increase in the prevalence of the Pro-,Cit-,Ura- auxotype in Canada since 1973 has been associated with an increase in penicillin-resistant isolates. The association between auxotype and plasmid carriage may also indirectly play a role in resistance of N. gonorrhoeae to antibiotics. Finally, the possibility that new plasmid-determined resistances may be acquired by N. gonorrhoeae from species of Haemophilus is reviewed.