Antimicrobial resistance in sexually transmitted infections: Emerging therapeutic challenges and the need for updated treatment strategies

Sexually transmitted infections (STIs) continue to represent a global health crisis, with more than one million curable cases diagnosed daily. Bacterial STIs, including Neisseria gonorrhoeae, Mycoplasma genitalium, Chlamydia trachomatis, and Treponema pallidum, were historically treatable, but are now increasingly resistant to first- and second-line antibiotics. Antimicrobial resistance (AMR) in these pathogens threatens the efficacy of established treatment regimens and poses a serious risk to global STI control strategies. This review synthesizes high-quality peer-reviewed research on resistance mechanisms, epidemiological trends, treatment failures, and diagnostic limitations across the four pathogens. We also examine current global surveillance efforts, limitations of syndromic management, and the urgent need for novel therapeutics. Understanding the evolving resistance patterns and their clinical implications is essential to prevent returning to the pre-antibiotic era in STI management.