A review of the current state of developing a vaccine against gonorrhea

What is it about?

Vaccination against gonorrhea has received renewed interest because of the emergence of strains of Neisseria gonorrhoeae that are resistant to most currently available antibiotics, threatening to render gonorrhea untreatable. However, efforts to create a vaccine have so far been unsuccessful. This review discusses various factors that have contributed to this situation, including the remarkable antigenic variation displayed by N. gonorrhoeae, its ability to resist destruction by innate defense mechanisms, its exclusive host restriction to humans, and an absence of a definable state of immunity arising from prior infection. Recent findings have revealed how the gonococcus exploits human-specific receptors for attachment to and invasion of tissues and subverts the host’s immune system for its own benefit. Experimental approaches based on human cells and tissues, various animal models including genetically modified strains of mice, and both experimental and observational studies in humans, have generated new insights into the pathogenesis of gonococcal infection and immune responses against it. These now make the development of an effective human vaccine against gonorrhea an achievable goal within the foreseeable future.

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Why is it important?

The worldwide incidence of gonorrhea is estimated to exceed 100 million cases each year, and resistance to all currently available antibiotics is increasing. While not usually life-threatening, untreated gonorrhea causes reproductive tract damage and morbidity especially in women, and can lead to infertility and increased risk of ectopic pregnancy which is life-threatening. It also increases the risk of acquisition and transmission of HIV. Bodies such as the World Health Organization and the US Centers for Disease Control and Prevention have therefore called for renewed efforts at effective vaccine development.