**1.5** *Neisseria gonorrhoeae* **antimicrobial resistance and epidemiology**

*N. gonorrhoeae* has a great ability to develop resistance mechanism to available first-line antibiotics, such as penicillin, fluoroquinolones, and tetracyclines, increasing the burden of multidrug-resistant *N. gonorrhoeae* [15]. The study of the evolution of antimicrobial resistance (AMR) shows that the resistance of *N. gonorrhoeae* has been driven by the widespread use and misuse of antibiotics, in view of the natural absence of AMR elements in this bacterium [2]. With the introduction of each new antibiotic, resistance soon followed: penicillins (1943, resistance developed since 1989), fluoroquinolones (the 1980s, no longer recommended in 2007), tetracyclines (1962, high-level resistance noted in 1985), sulfonamides (1930s, up to 90% resistance reported in 1940), spectinomycin (1961, emergence of resistance in 1987), and azithromycin (1983, no longer recommended in 2007), cefixime (1983, clinical failures in Japan in 2010), and ceftriaxone (1980, first highlevel resistance strain reported in 2009). Ceftriaxone is presently the last remaining empiric treatment option, highlighting the urgent need for research and development of new antibiotics and change in treatment regimens [2].

Indeed, the treatment failure, slow update of treatment guidelines in most countries, and the particular ability of the gonococci to develop and retain AMR make the global problem of gonococcal AMR worst in the foreseeable future. Consequently, severe complications of gonorrhea will emerge as a silent epidemic [13]. In fact, the WHO lists *N. gonorrhoeae* as a "priority pathogen", and reported over 78 million cases each year, with uncontrolled transmission and limited treatment options, untreatable gonorrhea will increase the incidence and complications from infections, like the infertility in women. Accordingly, the WHO established the Gonococcal Antimicrobial Surveillance Program (GASP) in 1992, to encourage countries to collect and report their AMR data for at least one antibiotic, in order to develop their own gonococcal AMR surveillance programs. Hence, the implementation of optimal surveillance programs is of utmost importance [2].
