Editing Neisseria gonorrhoeae (section)

==== Antibiotic resistance ====
[[Antibiotic resistance in gonorrhea]] was first identified in the 1940s. Gonorrhea was treated with penicillin, but doses had to be progressively increased to remain effective. By the 1970s, penicillin-and tetracycline-resistant gonorrhea emerged in the Pacific Basin. These resistant strains then spread to Hawaii, California, the rest of the United States, Australia and Europe. Fluoroquinolones were the next line of defense, but soon resistance to this antibiotic emerged, as well. Since 2007, standard treatment has been third-generation cephalosporins, such as ceftriaxone, which are considered to be our "last line of defense".<ref>{{cite news|url=https://www.bbc.co.uk/news/health-15238613|title=UK doctors advised gonorrhoea has turned drug resistant|date=10 October 2011|work=BBC News}}</ref><ref name="blog.advocatesaz.org">{{cite web | url = http://blog.advocatesaz.org/2012/03/06/sti-awareness-antibiotic-resistant-gonorrhea | archive-url = https://web.archive.org/web/20121105124828/http://blog.advocatesaz.org/2012/03/06/sti-awareness-antibiotic-resistant-gonorrhea/ | archive-date = 5 November 2012 | title = STI Awareness: Antibiotic-Resistant Gonorrhea | publisher = Planned Parenthood Advocates of Arizona | date = 6 March 2012 | access-date = 6 March 2012 }}</ref> Recently, a high-level ceftriaxone-resistant strain of gonorrhea called H041 was discovered in Japan. Lab tests found it to be resistant to high concentrations of ceftriaxone, as well as most of the other antibiotics tested. Within ''N. gonorrhoeae'', genes exist that confer resistance to every single antibiotic used to cure gonorrhea, but thus far they do not coexist within a single gonococcus. However, because of ''N. gonorrhoeae''{{'}}s high affinity for horizontal gene transfer, antibiotic-resistant gonorrhea is seen as an emerging public health threat.<ref name="blog.advocatesaz.org" />

Prior to 2007, [[fluoroquinolone]]s were a common treatment recommendation for gonorrhoeae. The CDC stopped suggesting these systemic bacterial agents once a resistant strain of ''N. gonorrhoeae'' emerged in the United States. The removal of fluoroquinolones as a potential treatment left [[cephalosporin]]s as the only viable antimicrobial option for gonorrhea treatment. Wary of further gonococcal resistance, the CDC's recommendations shifted in 2010 to a dual therapy strategy—cephalosporin with either [[azithromycin]] or [[doxycycline]]. Despite these efforts, resistant ''N. gonorrhoeae'' had been reported in five continents by 2011, further limiting treatment options and recommendations. Antimicrobial resistance is not universal and ''N. gonorrhoeae'' strains in the United States continue to respond to a combination regimen of [[ceftriaxone]] and azithromycin.<ref name="pmid35015033">{{cite journal |vauthors=Tuddenham S, Hamill MM, Ghanem KG |title=Diagnosis and Treatment of Sexually Transmitted Infections: A Review |journal=JAMA |volume=327 |issue=2 |pages=161–172 |date=January 2022 |pmid=35015033 |doi=10.1001/jama.2021.23487 |url=}}</ref>