Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium

The burden of Neisseria gonorrhoeae and Mycoplasma genitalium infections and multidrug-resistance in the aetiological agents are major global public health concerns that are poorly surveyed and controlledN. gonorrhoeae and M. genitalium are evolving into so-called superbugs; infections with these bacteria have become exceedingly difficult to treat and they might become untreatable in certain circumstancesCurrent dual antimicrobial therapy for gonorrhoea (ceftriaxone plus azithromycin) should be considered in all settings where regular, local and quality-assured antimicrobial resistance (AMR) data do not support other therapeutic optionsDual antimicrobial therapy might also need to be considered for M. genitalium infectionsDevelopment of novel antimicrobials and treatment algorithms that emphasizes dual antimicrobial therapy and AMR testing is imperative to minimize AMR emergence, enhance AMR surveillance and, ideally, guide personalized treatmentSome newly developed antimicrobials, for example the fluoroketolide solithromycin, the spiropyrimidinetrione zoliflodacin and the pleuromutilin lefamulin, need further evaluation in clinical trials as potential future treatments of gonorrhoea and M. genitalium infections