Gonorrhea Management in High-, Limited- and No-Resource Settings: Implications in the Context of Antimicrobial...

Gonorrhea, a common sexually transmitted infection caused by Neisseria gonorrhoeae, represents an escalating global public health threat due to antimicrobial resistance. The current review explores diverse approaches around the globe to gonorrhea management across various settings, with a focus on diagnostic strategies, treatment practices, resistance surveillance, and new trends, such as point-of-care tests or doxycycline post-exposure prophylaxis. High-resource settings benefit from proper infrastructure, advanced diagnostics, screening programs, surveillance, access to effective treatment, and test-of-cure protocols. Nonetheless, rising incidence and resistance rates persist. In contrast, limited-resource settings often depend on syndromic management, which lacks sensitivity and fails to identify asymptomatic infections. The low diagnostic capacity and poor access to resistance-guided therapy contribute to inappropriate antimicrobial use. Migrants, incarcerated individuals, and those in vulnerable contexts face additional barriers. These disparities undermine the global control efforts and enable the emergence of drug-resistant strains. Addressing these gaps requires a multifaceted, equity-focused approach: strengthening diagnostic capacity, expanding access to molecular testing and surveillance, tailored interventions for the local contexts, and promoting antibiotic stewardship in both policy and practice.