Intended for healthcare professionals


The prospect of untreatable gonorrhoea

BMJ 2017; 358 doi: (Published 25 August 2017) Cite this as: BMJ 2017;358:j3973
  1. Alan P Johnson, professor,
  2. Gwenda Hughes, , consultant epidemiologist
  1. National Infection Service, Public Health England, London, UK
  1. Correspondence to: A P Johnson alan.johnson{at}

An international threat that requires a coordinated international response

Antibiotics are unlike other drugs used in medicine in that the more they are used the less effective they become. Their widespread use provides a strong selective pressure for the emergence and spread of bacteria that have developed resistance, reflecting Charles Darwin’s concept of the survival of the fittest. Many bacterial infections are thus becoming increasingly difficult to treat, and among them is the sexually transmitted infection gonorrhoea, which is the second most common bacterial sexually transmitted infection in the UK.1

Untreated infection can lead to a range of complications, including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility. In rare instances the infecting bacterium, Neisseria gonorrhoeae, can invade the bloodstream causing septic arthritis or endocarditis.2 Thus the possible widespread occurrence of untreatable gonorrhoea is a serious public health threat. This was recently highlighted by the World Health Organization (WHO), which reported that antibiotic resistant strains of N gonorrhoeae have been detected …

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