Superbugs Neisseria gonorrhoeae und Mycoplasma genitalium: Therapeutische Herausforderungen durch antimikrobielle Resistenzen

The incidence of sexually transmitted diseases continues to rise. According to the most recent European Centre for Disease Prevention and Control (ECDC) data, infections with Neisseria (N.) gonorrhoeae have increased by more than 300% over the past 10 years. The growing antimicrobial resistance of N. gonorrhoeae and Mycoplasma (M.) genitalium is leading to infections that are increasingly difficult to treat. Multidrug-resistant strains ("superbugs") cause persistent infections and increased transmission. Thus, a review of recent studies and current guidelines was conducted. N. gonorrhoeae is showing increasing resistance to penicillins, tetracyclines, and fluoroquinolones; furthermore, there is a growing reduction in susceptibility to the macrolide antibiotic azithromycin. Resistance rates to ceftriaxone, the current first-line therapy in many international treatment guidelines, and to cefixime, the peroral treatment option frequently used in outpatient settings, remain very low in German-speaking countries. For M. genitalium, increasing resistance is observed primarily to macrolides and, less commonly, to fluocinolones; cases of infections with combined resistance to both antimicrobial classes have been reported and regularly require the use of reserve antibiotics such as pristinamycin or sitafloxacin. Enhanced surveillance, molecular resistance testing, avoidance of overdiagnosis, rational and responsible antibiotic use (preventing overtreatment), and the development and implementation of new antimicrobial agents are crucial for sustainable infection control.