{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:20:04Z","timestamp":1792110004452,"version":"4.4.0"},"reference-count":124,"publisher":"CSIRO Publishing","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":2082,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,13]]},"abstract":"<jats:p>Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015\u201316, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and\/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.<\/jats:p>","DOI":"10.1071\/sh19023","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T19:38:16Z","timestamp":1566502696000},"page":"412-425","source":"Crossref","is-referenced-by-count":244,"title":["World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts"],"prefix":"10.1071","volume":"16","author":[{"given":"Magnus","family":"Unemo","sequence":"first","affiliation":[{"name":"AWorld Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, \u00d6rebro University, SE-701 85 \u00d6rebro, Sweden."},{"name":"KCorresponding author. Email: magnus.unemo@regionorebrolan.se"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Lahra","sequence":"additional","affiliation":[{"name":"BWorld Health Organization Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, New South Wales Health Pathology, Microbiology, Randwick, NSW, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Cole","sequence":"additional","affiliation":[{"name":"CNational Infection Service, Public Health England, London, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Galarza","sequence":"additional","affiliation":[{"name":"DNational Reference Laboratory for STDs, National Institute of Infectious Diseases \u2013 ANLIS \u2018Dr Carlos G. Malbr\u00e1n\u2019, Buenos Aires, Argentina."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Ndowa","sequence":"additional","affiliation":[{"name":"ESkin and Genitourinary Medicine Clinic, Harare, Zimbabwe."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Martin","sequence":"additional","affiliation":[{"name":"FPublic Health Agency of Canada, National Microbiology Laboratory, Winnipeg, MB, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo-Anne R.","family":"Dillon","sequence":"additional","affiliation":[{"name":"GUniversity of Saskatchewan, Saskatoon, SK, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Ramon-Pardo","sequence":"additional","affiliation":[{"name":"HCommunicable Diseases and Environmental Determinants of Health Department Pan American Health Organization\/World Health Organization, Washington, DC, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Bolan","sequence":"additional","affiliation":[{"name":"IDivision of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Wi","sequence":"additional","affiliation":[{"name":"JDepartment of Reproductive Health and Research, World Health Organization, Geneva, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"67","published-online":{"date-parts":[[2019,8,23]]},"reference":[{"key":"2025102419094573400_R1","unstructured":"World Health Organization (WHO). Report on global sexually transmitted infection surveillance, 2018. Geneva: WHO; 2018. Available online at: https:\/\/www.who.int\/reproductivehealth\/publications\/stis-surveillance-2018\/en\/ [verified February 2019]."},{"key":"2025102419094573400_R2","doi-asserted-by":"publisher","first-page":"1868","DOI":"10.1016\/S0140-6736(97)02190-9","article-title":"Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1.","volume":"349","author":"Cohen","year":"1997","journal-title":"Lancet"},{"key":"2025102419094573400_R3","unstructured":"World Health Organization (WHO). Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. Available online at: http:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/9789241503501\/en\/ [verified 28 June 2019]."},{"key":"2025102419094573400_R4","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1128\/CMR.00010-14","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future.","volume":"27","author":"Unemo","year":"2014","journal-title":"Clin Microbiol Rev"},{"key":"2025102419094573400_R5","unstructured":"World Health Organization (WHO). WHO guidelines for the treatment of Neisseria gonorrhoeae. Geneva: WHO; 2016. Available online at: http:\/\/www.who.int\/reproductivehealth\/publications\/rtis\/gonorrhoea-treatment-guidelines\/en\/ [verified 28 June 2019]."},{"key":"2025102419094573400_R6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002344","article-title":"Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action.","volume":"14","author":"Wi","year":"2017","journal-title":"PLoS Med"},{"key":"2025102419094573400_R7","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1186\/s12879-017-2707-z","article-title":"Overall low extended-spectrum cephalosporin resistance but high azithromycin resistance in Neisseria gonorrhoeae in 24 European countries, 2015.","volume":"17","author":"Cole","year":"2017","journal-title":"BMC Infect Dis"},{"key":"2025102419094573400_R8","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1186\/s12879-018-3528-4","article-title":"Stably high azithromycin resistance and decreasing ceftriaxone susceptibility in Neisseria gonorrhoeae in 25 European countries, 2016.","volume":"18","author":"Day","year":"2018","journal-title":"BMC Infect Dis"},{"key":"2025102419094573400_R9","doi-asserted-by":"publisher","first-page":"3538","DOI":"10.1128\/AAC.00325-11","article-title":"Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea? 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