CHAPTER ONE

INTRODUCTION

        Despite the recent advances in diagnosis, surveillance and treatment, sexual transmitted disease (STDs) remain one of the leading diseases throughout the world. Increased promiscuity and onset of sexual activity at an early age are two important contributing factors to the spread of sexual transmitted disease.  Neisseria gonorrhea (also known as the gonococcus) colonizes primarily in the human genital urinary tract, giving rise to the sexually transmitted infection gonorrhea.  It cause both symptomatic and asymptomatic genital and extra genital tract infections.  Disease caused by this organism is a significant public health problem despite continual advances in treatment (Tanaka and Reyn et al, 2004).

Worldwide, there is an estimated 62million new cases a year, with an average of 22miilion cases at any given time (WHO, 1992).  N. gonorrhea inhabits mainly mucosal surface of the urethra in males and the cervix in females.  As the signs and symptoms of infection are often absent or obscure complication such as pelvic inflammatory disease (PID), infertility, entopic pregnant woman may lead to crucial perforation and blindness in the newborn. Gonococci infection have also been documented to facilitate acquisition and transmission of HIV and HPV infection (Hunter et al. 1990).  Asymptomatic infections by N. gonorrhoeae largely contribute to the persistence and transmission of disease in a community. (Hunter et, al.1990).

Therefore, to eliminate N. gonorrhea infection and in turn to control HIV and HPV infection it is important not only to screen high – risk population but also to treat them immediately with most effective drugs.  Control of gonococci infection has relied on effective single – dose antibiotic therapy given at the initial clinical visit, prior to any knowledge of the organism’s susceptibility pattern.  In the recent past, there has been an alarming increase in the number of isolate of N. gonorrhea resistance to commonly used drugs.  (Chaudhry et al, 2002).  Surveillance is, therefore, necessary to understand on going resistance trends and to ensure the success of any therapy.

The irrational and injudicious use of antibacterial agents especially in the developing countries is encouraging this trend and the situation is expected to worsen unless appropriate steps are initiated. This resistance of the gonococcus to antibiotics has been the cause of much concern in recent years and has been the subject of extensive investigation.  The present review summarizes and trends to drug resistance in N. gonorrhoeae, mechanism of drug resistance and discusses the treatment regime.  In addition, the need to look for new and alternative antibacterial agent is also emphasized.

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