Abstract
The World Health Organization (WHO) has placed N. gonorrhoeae on the global priority list of antimicrobial resistant pathogens and is urgently seeking the development of new intervention strategies. N. gonorrhoeae causes 86.9 million cases globally per annum. The effects of gonococcal disease are seen predominantly in women and children and especially in the Australian Indigenous community. While economic modelling suggests that this infection alone may directly cost the USA health care system USD 11.0–20.6 billion, indirect costs associated with adverse disease and pregnancy outcomes, disease prevention, and productivity loss, mean that the overall effect of the disease is far greater still. In this review, we summate the current progress towards the development of a gonorrhea vaccine and describe the clinical trials being undertaken in Australia to assess the efficacy of the current formulation of Bexsero® in controlling disease.
Highlights
Gonorrhea is a sexually transmitted infection (STI) caused by the Gram-negative bacteria Neisseria gonorrhoeae
While the primary aim of this study is to examine the carriage of N. meningitidis in the nasopharynx, there is a secondary observational arm which will compare the rates of gonorrhea in the vaccinated versus unvaccinated participants
Interest in the development of a vaccine against N. gonorrhoeae has grown in recent years, given the increasing reports of antimicrobial resistant (AMR) strains and the promising evidence of crossprotection of MenB vaccines indicating the biological feasibility of a gonococcal vaccine
Summary
Gonorrhea is a sexually transmitted infection (STI) caused by the Gram-negative bacteria Neisseria gonorrhoeae ( called gonococcus). Interest in vaccine development against N. gonorrhoeae has been revived recently by both the increased global interest in the use of vaccines to fight AMR bacteria [9,14] and observational studies reporting that vaccines developed against the closely related pathogen Neisseria meningitidis ( called meningococcus) serogroup B (MenB) might provide moderate protection against gonorrhea [15,16,17] While these studies provide promise that vaccines against N. gonorrhoeae are biologically feasible, they reinforce the need to characterize the full immune response in mice and for human clinical trials to determine the efficacy of vaccine antigens. Antibodies against the surface reduction modifiable protein Rmp (previously referred to as protein III) could interfere with protective immunity as they block the activity of bactericidal antibodies targeting gonococcal surface antigens [116,117,118] Given all these mechanisms for immune evasion and modulation, individuals can be repeatedly infected with no development of immunological memory that can prevent natural reinfection. It is unsurprising that early vaccine attempts with a killed whole cell vaccine and single antigen pilus and PorB vaccines were unsuccessful [119,120,121,122,123,124]
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