Antibiotics have kept most sexually transmitted infections (STIs) out of the public eye. However, in times of increasing resistance to almost all classes of antibiotics, this certainty may soon be lost. In particular, Neisseria gonorrhoeae and Mycoplasma genitalium are increasingly showing resistance to current treatment strategies.
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The bacterium Neisseria gonorrhoeae (gonococcus) causes what is colloquially known as “gonococcus,” which in men almost always presents as urethritis, itching, purulent discharge, and dysuria. On the one hand, 50 percent of affected women remain asymptomatic, but on the other hand they can develop a more complex clinical picture with local inflammatory reactions in the genitourinary tract up to acute abdomen. In addition to these local symptoms in a broader sense, disseminated gonococcal infection with hemorrhagic skin changes, sepsis and dissemination of the hematogenous pathogen, for example with septic arthritis, can also occur in both sexes. Gonorrhea is treated with a single dose of ceftriaxone plus azithromycin according to local recommendations. For disseminated infections, treatment is more complex and includes parenteral ceftriaxone until symptoms resolve, followed by oral antibiotic treatment for a week.