Evidence-Based Assessment of the Role of Pharyngeal Gonorrhea and Commensal <i>Neisseria</i> Species in the Emergence of Antimicrobial Resistance in <i>Neisseria Gonorrhoeae</i> : Data Gaps and Future Research

Antimicrobial resistance in Neisseria gonorrhoeae (NG) represents a global public health threat; NG has progressively developed resistance to current and previously recommended antibiotics. Pharyngeal NG infections contribute to the sustained transmission of gonorrhea as pharyngeal infections are often asymptomatic and remain undiagnosed. Pharyngeal NG infections play a major role in the emergence of antimicrobial resistance in NG as horizontal gene transfer is common between NG and commensal Neisseria species which colonize the oropharynx. We review the evidence on the contribution of pharyngeal NG and commensal Neisseria species to the emergence of antimicrobial resistance in NG and outline research gaps. Improved understanding of pharyngeal NG pathogenesis and how NG acquires antimicrobial resistance markers through horizontal gene transfer from commensal Neisseria species is critical to curtail the rapid evolution of NG antimicrobial resistance.