Updates bei der Behandlung von Gonokokken-Infektionen

The numbers of cases of infections with Neisseria gonorrhoeae (NG) are constantly increasing worldwide. A significant proportion of NG cases are asymptomatic extragenital infections detected during screening for sexually transmitted infections (STI). In Europe, most severely affected is the group of men who have sex with men (MSM). Ever since antibiotics became available as a treatment for gonorrhea almost one century ago, the management of NG infections has been challenged by the emergence of antimicrobial resistance (AMR). Up to now, NG has developed resistance against every therapeutic agent established as standard treatment. A substantial increase in resistance against azithromycin has recently been observed. This has significant implications for the standard treatment as the combination of ceftriaxone and azithromycin has been established as the first-line treatment for NG over the past 10 years. Therefore, current treatment is based on ceftriaxone monotherapy after the exclusion of a chlamydia coinfection and a subsequent test of cure. The most important preventive measure for NG transmission is still the condom, as an effective vaccination is so far not available and chemoprophylaxis with doxycycline has a very limited efficacy in NG transmission prevention.