Deciphering the Impact of Bystander Selection for Antibiotic Resistance in Neisseria gonorrhoeae

The challenges facing clinical and public health management of gonorrhea are mounting [1]. The number of gonorrhea cases in the United States increased 18% from 2016 to 2017. Rising frequencies of antimicrobial resistance imperil the effectiveness of current therapies and increase the risk of widespread treatment failures [2, 3]. In a multifaceted strategy to meet these challenges, including the development of rapid point-of-care diagnostic assays that enable the use of antibiotics previously abandoned for empirical treatment, work on vaccines to limit acquisition and transmission, and campaigns to promote safe sex, new antibiotics are urgently needed [1]. However, as with each previous antibiotic, we can expect that gonococcal resistance to new antibiotics will emerge [4]. To maximize and prolong the effectiveness of antibiotics new and old, we need to understand the factors that drive resistance and determine the extent to which modulating those factors could contribute to slowing or controlling antimicrobial resistance.