Better understanding of the international epidemiology of gonorrhoea may inform national and international prevention and control strategies. We review the current epidemiology of gonorrhoea through an international lens. Sexual, gender, racial and ethnic minorities are disproportionately affected by gonorrhoea, but gaps in knowledge, such as the epidemiology of gonorrhoea among transgender people, should be addressed.

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae has made gonorrhoea exceedingly difficult to treat, and untreatable gonorrhoea can be a reality. This paper describes the World Health Organization Gonococcal Antimicrobial Surveillance Program (WHO GASP) data from 67 countries in 2015–16 and confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, highlights the urgent need for molecular AMR surveillance and describes essential international collaborative actions and research efforts.

Development of vaccines against Neisseria gonorrhoeae has become increasingly important because of rising gonococcal antimicrobial resistance. Recent data suggests serogroup B Neisseria meningitidis vaccines may provide some cross-protection against gonorrhoea, offering hope that gonococcal vaccines are also feasible. This article reviews development approaches for gonorrhoea vaccines and outlines action steps from the Global STI Vaccine Roadmap to address the epidemiological, scientific, programmatic and policy considerations needed to advance gonococcal vaccine development.

The rise in antibiotic-resistant gonorrhoea is a global public health threat. Mouthwash has been proposed as a novel non-antibiotic intervention for gonorrhoea prevention and is currently under investigation in a randomised controlled trial. This review summarises the current evidence of mouthwash use for gonorrhoea prevention and identifies potential research in the future.

This article reviews the literature pertaining to azithromycin alone or as a component of dual therapy for gonorrhoea, at a time when resistance is a real threat. We conclude that there is insufficient evidence to support the use of azithromycin (1 g) as treatment for gonorrhoea, hence the rationale to use this alongside parenteral ceftriaxone as dual treatment may be flawed. Higher efficacy is reported using a 2 g dose of azithromycin, but this is poorly tolerated and has not been extensively investigated as treatment for extra-genital gonorrhoea.

Neisseria gonorrhoeae has evolved into a ‘superbug’ and gonorrhoea will become harder to treat in the next decade. This review describes opportunities to recycle old drugs and reposition those therapeutic agents not traditionally used to treat gonorrhoea; it also provides an overview of new drugs in late stage clinical development. Early effective treatment of gonorrhoea will make a substantial contribution to overall containment of antimicrobial resistance within communities.

The incidence of gonorrhoea among gay and bisexual men attending Australian sexual health clinics increased dramatically from 2010 to 2017, most prolifically in pharyngeal and anorectal infections. Enhanced prevention and network-driven research efforts are required to effectively combat gonorrhoea among gay and bisexual men.

Research into chemsex has shown links with HIV and high-risk sexual behaviour, but other sexually transmissible infections (STIs) have been largely ignored. We investigated whether risk of gonorrhoea was higher among gay and bisexual men using chemsex drugs – which we found to be true for crystal methamphetamine and γ-hydroxybutyric acid/γ-butyrolactone (GHB/GBL). This points to chemsex playing a role in driving transmission and provides a key target group for intervention.

Mouthwash use may be an effective intervention for prevention and control of throat gonorrhoea. This study sought to determine the association between specific oral sex practices and frequency of mouthwash use in order to better inform future public health campaigns targeted at increasing mouthwash use. Younger men who have sex with men are less likely to use mouthwash and no association between mouthwash use and oral sex practices was discovered.

Successful treatment of sexually transmissible infections is threatened by increasing rates of antimicrobial resistance. This study reviewed existing work on specific DNA sequences and their link to resistance in Neisseria gonorrhoeae, and evaluated these sequences to identify accurate markers of resistance for two treatments of gonorrhoea. If incorporated into diagnostic tests, these could allow diagnosis of the infection and its resistance pattern together, improving treatment efficacy and preventing further spread of resistance.

As Neisseria (N.) gonorrhoeae develops resistance to various classes of antibiotics worldwide, quickly determining its susceptibility to an antibiotic can help physicians make better clinical decisions. A parsimonious molecular test detecting alterations at six amino acid positions in one gene is necessary and might also be sufficient to predict whether a strain is susceptible to cefixime. Assays like this allow for targeted therapy and might slow down the emergence of antimicrobial resistance.

Currently, there are a lack of standardised approaches to investigating Neisseria gonorrhoeae cases that fail treatment. This study investigates the utility of whole-genome sequencing to discriminate cases where treatment has failed from cases of reinfection diagnostic. Here we demonstrate that whole-genome sequencing provides a more accurate diagnostic tool for identifying cases where treatment has failed.

Sex with a partner from overseas has been linked to rising rates of gonorrhoea in heterosexual women. This study aimed to see if sex with an overseas partner was a risk factor for men as well. Having sex with a partner from a high-risk country was a risk factor for men, however, there are likely other causes behind the recent rising gonorrhoea rates in men.

Untreatable gonorrhoea is a real possibility, with increasing reports of resistance to antibiotics used to treat this infection. A mathematical model was created to explore different strategies of treating gonorrhoea, including the use of rapid testing for resistance so that older drugs (ciprofloxacin) may be used. We show that utilising this strategy can significantly reduce the use of unnecessary antibiotics.

We looked to examine how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. We analysed 110 cases, mostly symptomatic, and found that of five parameters of care, none was documented in most cases. Gonorrhoea diagnosed in hospitals needs to be managed in concert with the broader public health response.