{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T09:03:49Z","timestamp":1785229429772,"version":"3.55.0"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Antimicrobial resistance in Neisseria gonorrheae threatens the effectiveness of empirical gonorrhoea treatment. Although global surveillance evidence is increasingly available, resistance data are not consistently reported separately for men with urethral or urogenital infection. This review evaluated antibiotic-specific resistance in N. gonorrhoeae isolates from this clinically defined population and examined the geographic and reporting limitations of the available evidence. Materials and Methods: PubMed, Scopus, ScienceDirect, Google Scholar, and relevant WHO GASP\/EGASP resources were searched from inception to [updated search date]. Eligible observational or surveillance studies reported categorical resistance classifications or extractable antibiotic-specific resistant counts and denominators for male urethral or urogenital isolates. Antibiotic-specific proportions were synthesized using random-effects meta-analysis where pooling was considered appropriate. Sparse-event outcomes were additionally evaluated using study-specific estimates and aggregate resistant\/tested counts. Certainty of evidence was assessed using the GRADE framework adapted for prevalence outcomes. Results: Six studies met the eligibility criteria, including the 2025 multinational EGASP study. Cefixime resistance was reported in 748 of 13,154 isolates, corresponding to an aggregate proportion of 5.69%; however, the random-effects estimate was unstable because three studies reported no resistant isolates and events were concentrated in two large datasets. Ceftriaxone resistance varied from 0% to 5.17%, with a pooled estimate of 0.32% (95% CI 0.05\u20132.15; I2 = 97.8%). Resistance was high but heterogeneous for ciprofloxacin (71.84%, 95% CI 7.53\u201398.77; I2 = 97.3%) and penicillin (62.47%, 95% CI 36.87\u201382.58; I2 = 98.1%). Spectinomycin resistance was 2.57% (95% CI 1.58\u20134.16; I2 = 0%), while azithromycin resistance was 6.38% (95% CI 4.38\u20139.21; I2 = 94.9%). Certainty of evidence was very low for all outcomes. Conclusions: Evidence specifically reporting resistance in male urethral or urogenital N. gonorrhoeae isolates remains limited and geographically uneven. Contemporary EGASP data demonstrate that ceftriaxone resistance is not uniformly low across surveillance settings. The pooled estimates should be interpreted as exploratory summaries rather than current global prevalence values or an independent basis for treatment selection. Standardized reporting of sex, anatomical site, breakpoints, MIC distributions, and resistant\/tested counts is needed to improve future surveillance synthesis.<\/jats:p>","DOI":"10.3390\/medicina62081457","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:55:41Z","timestamp":1785225341000},"page":"1457","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial Resistance in Neisseria gonorrhoeae Isolates from Men with Urethral or Urogenital Infection: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1416-7517","authenticated-orcid":false,"given":"Daurenbek","family":"Sengirbayev","sequence":"first","affiliation":[{"name":"Urology Department, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marat","family":"Batyrbekov","sequence":"additional","affiliation":[{"name":"Urology Department, Asfendiyarov Kazakh National Medical University, 050012 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhakhanger","family":"Tursunov","sequence":"additional","affiliation":[{"name":"Science Department, Kazakhstan\u2019s Medical University \u201cKSPH\u201d, 050060 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2893-2996","authenticated-orcid":false,"given":"Ulugbek","family":"Medeubekov","sequence":"additional","affiliation":[{"name":"Science Department, Kazakh Scientific Center of Dermatology and Infectious Diseases, 050008 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7988-433X","authenticated-orcid":false,"given":"Tilek","family":"Kassymov","sequence":"additional","affiliation":[{"name":"Scientific Center of Urology named after Academician B.U. Dzharbusynov, 050060 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Rysuly","sequence":"additional","affiliation":[{"name":"Science Department, Kazakh Scientific Center of Dermatology and Infectious Diseases, 050008 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1796-2604","authenticated-orcid":false,"given":"Indira","family":"Karibayeva","sequence":"additional","affiliation":[{"name":"Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7349-2059","authenticated-orcid":false,"given":"Zhansaya","family":"Sultanbayeva","sequence":"additional","affiliation":[{"name":"Science Department, Kazakh Eye Research Institute, 050012 Almaty, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e627","DOI":"10.1016\/S2666-5247(21)00171-3","article-title":"WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017-18: A retrospective observational study","volume":"2","author":"Unemo","year":"2021","journal-title":"Lancet Microbe"},{"key":"ref_2","unstructured":"World Health Organization (2025, October 22). Gonorrhoea. WHO Fact Sheets. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/gonorrhoea."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1038\/s41572-019-0128-6","article-title":"Gonorrhoea","volume":"5","author":"Unemo","year":"2019","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/S0891-5520(20)30096-9","article-title":"Gonococcal infections","volume":"1","author":"Dallabetta","year":"1987","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e26325","DOI":"10.1002\/jia2.26325","article-title":"The HIV epidemic in eastern Europe and central Asia in difficult times: A story of resilience and change","volume":"27","author":"Parczewski","year":"2024","journal-title":"J. Int. AIDS Soc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.1111\/j.1749-6632.2011.06215.x","article-title":"Antibiotic resistance in Neisseria gonorrhoeae: Origin, evolution, and lessons learned for the future","volume":"1230","author":"Unemo","year":"2011","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_7","unstructured":"World Health Organization (2016). WHO Guidelines for the Treatment of Neisseria Gonorrhoeae, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241549691."},{"key":"ref_8","unstructured":"(2025, November 19). Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP): Gonorrhoea Treatment Optimization, 2025 Report; ISBN: 978-92-4-011729-7. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240117297."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Wi, T., Lahra, M.M., Ndowa, F., Bala, M., Dillon, J.R., Ramon-Pardo, P., Eremin, S.R., Bolan, G., and Unemo, M. (2017). Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action. PLoS Med., 14.","DOI":"10.1371\/journal.pmed.1002344"},{"key":"ref_10","unstructured":"Centers for Disease Control and Prevention (2024, February 15). Antibiotic-Resistant Gonorrhea, Available online: https:\/\/www.cdc.gov\/gonorrhea\/hcp\/drug-resistant\/index.html."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Hooshiar, M.H., Sholeh, M., Beig, M., Azizian, K., and Kouhsari, E. (2024). Global trends of antimicrobial resistance rates in Neisseria gonorrhoeae: A systematic review and meta-analysis. Front. Pharmacol., 15, Erratum in Front. Pharmacol.\u00a02024, 15, 1465628. https:\/\/doi.org\/10.3389\/fphar.2024.1465628.","DOI":"10.3389\/fphar.2024.1284665"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1177\/0956462419886775","article-title":"2018 UK national guideline for the management of infection with Neisseria gonorrhoeae","volume":"31","author":"Fifer","year":"2020","journal-title":"Int. J. STD AIDS"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1071\/SH19061","article-title":"Epidemiology of gonorrhoea: A global perspective","volume":"16","author":"Kirkcaldy","year":"2019","journal-title":"Sex. Health"},{"key":"ref_14","unstructured":"National Institute for Health and Care Research (2024, March 27). PROSPERO International Prospective Register of Systematic Reviews. Available online: https:\/\/www.crd.york.ac.uk\/prospero\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_16","unstructured":"(2024, January 22). Posit Team RStudio: Integrated Development Environment for R. Available online: http:\/\/www.posit.co\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/OLQ.0b013e3181bf575c","article-title":"Neisseria gonorrhoeae antimicrobial susceptibility in Lilongwe, Malawi, 2007","volume":"37","author":"Brown","year":"2010","journal-title":"Sex. Transm. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1038\/nrurol.2016.268","article-title":"Antimicrobial-resistant sexually transmitted infections: Gonorrhoea and Mycoplasma genitalium","volume":"14","author":"Unemo","year":"2017","journal-title":"Nat. Rev. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.ijid.2018.10.030","article-title":"Antimicrobial resistance and molecular characteristics of Neisseria gonorrhoeae isolates from men who have sex with men","volume":"79","author":"Calado","year":"2019","journal-title":"Int. J. Infect. Dis."},{"key":"ref_20","first-page":"3","article-title":"Behavioural characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo, Malawi","volume":"15","author":"Zachariah","year":"2003","journal-title":"Malawi Med. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"iv24","DOI":"10.1136\/sextrans-2013-051166","article-title":"Antimicrobial resistance monitoring in Neisseria gonorrhoeae and strategic use of funds from the Global Fund to set up a systematic Moroccan gonococcal antimicrobial surveillance programme","volume":"89","author":"Ndowa","year":"2013","journal-title":"Sex. Transm. Infect."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fentaw, S., Abubeker, R., Asamene, N., Assefa, M., Bekele, Y., and Tigabu, E. (2020). Antimicrobial susceptibility profile of Gonococcal isolates obtained from men presenting with urethral discharge in Addis Ababa, Ethiopia: Implications for national syndromic treatment guideline. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0233753"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e17009","DOI":"10.2196\/17009","article-title":"Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report","volume":"6","author":"Workneh","year":"2020","journal-title":"JMIR Public Health Surveill."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Jacobsson, S., Cole, M.J., Spiteri, G., Day, M., Unemo, M. (2021). Associations between antimicrobial susceptibility\/resistance of Neisseria gonorrhoeae isolates in European Union\/European Economic Area and patients\u2019 gender, sexual orientation and anatomical site of infection, 2009\u20132016. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-05931-0"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e478","DOI":"10.1016\/S2666-5247(23)00370-1","article-title":"Antimicrobial-resistant Neisseria gonorrhoeae in Europe in 2020 compared with in 2013 and 2018: A retrospective genomic surveillance study","volume":"5","author":"Golparian","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1093\/jac\/dkae075","article-title":"Recent dynamics in Neisseria gonorrhoeae genomic epidemiology in Brazil: Antimicrobial resistance and genomic lineages in 2017\u201320 compared with 2015\u201316","volume":"79","author":"Golparian","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.3201\/eid3008.240139","article-title":"Surge in ceftriaxone-resistant Neisseria gonorrhoeae FC428-like strains, Asia-Pacific region, 2015\u20132022","volume":"30","author":"Xiu","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1093\/infdis\/jiaf071","article-title":"High prevalence of ceftriaxone-resistant Neisseria gonorrhoeae in Hanoi, Vietnam, 2023\u20132024","volume":"232","author":"Laumen","year":"2025","journal-title":"J. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3332","DOI":"10.1093\/jac\/dkae369","article-title":"Ceftriaxone-resistant Neisseria gonorrhoeae detected in England, 2015\u20132024: An observational analysis","volume":"79","author":"Fifer","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.mcna.2023.08.015","article-title":"The management of gonorrhea in the era of emerging antimicrobial resistance: What primary care clinicians should know","volume":"108","author":"Quilter","year":"2024","journal-title":"Med. Clin. N. Am."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e532","DOI":"10.1016\/S1473-3099(24)00001-X","article-title":"Managing treatment failure in Neisseria gonorrhoeae infection: Current guidelines and future directions","volume":"24","author":"Fifer","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1093\/jac\/dkae176","article-title":"The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains: Phenotypic, genetic and reference genome characterization","volume":"79","author":"Unemo","year":"2024","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1457\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T08:34:52Z","timestamp":1785227692000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/8\/1457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medicina62081457"],"URL":"https:\/\/doi.org\/10.3390\/medicina62081457","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]}}}