Gonorrhoea, caused by the bacterium Neisseria gonorrhoeae, is the second most common bacterial sexually transmitted infection diagnosed in the UK. Diagnoses remain highest among specific population groups: men who have sex with men, young people aged 15-24 years, and individuals of black Caribbean and mixed ethnicities. While most infections are asymptomatic, gonococcal infection can cause painful urogenital symptoms and, left untreated, can result in complications including pelvic inflammatory disease, epididymo-orchitis and infertility. Although infections can be treated successfully, there has been a concerning rise in diagnoses of antibiotic-resistant gonorrhoea in recent times. Treatment options are limited due to antimicrobial resistance and a lack of newer treatment options available. Sexual contacts should be treated if they test positive. Ceftriaxone remains a safe, effective first-line treatment. Ceftriaxone-resistant cases are being detected more frequently although numbers remain low in England and Wales. The recent roll-out of the world's first vaccination programme to protect against gonorrhoea infection is anticipated to save the NHS millions of pounds over the next decade. It remains to be seen whether this measure will effectively curb escalating national infection rates.

Overview of: Ravensberg J, Gussekloo J, Le Cessie S, et al Discontinuation of levothyroxine in adults aged 60 years or older. JAMA 2026;335:1491-1498. doi:10.1001/jama.2026.2864.

Polyendocrine metabolic ovarian syndrome (PMOS), previously named polycystic ovary syndrome, is a common endocrine disorder in women of reproductive age. It is associated with excessive levels of androgens and ovulatory dysfunction and has reproductive, metabolic and psychological impacts across the lifespan. Pharmacotherapy in PMOS should be directed at the concerns of the individual patient and may include the combined contraceptive pill, antiandrogen agents, metformin, antiobesity agents and ovulation induction agents. A narrative review of non-hormonal therapies was conducted. Metformin is associated with modest reductions in body weight and improves metabolic and anthropometric outcomes. Glucagon-like peptide-1 receptor agonists are an attractive option for weight loss although specific data in PMOS populations remain limited and there are safety considerations in the periconceptual setting. For ovulation induction, letrozole is the first-line agent of choice based on reassuring safety and efficacy data.

Chronic kidney disease (CKD) affects approximately 14% of adults worldwide, and CKD independently contributes to cardiovascular risk. Hereby, we provide a narrative review of cholesterol-lowering therapies for people with CKD. Abnormal levels of cholesterol and triglycerides are common in CKD and contribute to cardiovascular risk beyond common risk factors like older age, hypertension and diabetes, although the role of cholesterol and triglycerides in kidney disease progression remains uncertain. 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors (statins), alone or combined with ezetimibe, are the most extensively studied treatment in reducing cholesterol and lipids in CKD. Large randomised controlled trials (RCTs) and meta-analyses show statins reduce cardiovascular events and death in CKD, but not in people requiring dialysis despite similar cholesterol-lowering effects. Statins may also improve kidney function but have not demonstrated a benefit in reducing kidney failure. Current clinical guidelines recommend statins, with or without ezetimibe, for most adults with CKD, with therapy individualised based on age, kidney function and cardiovascular risk. However, guidelines in CKD do not indicate any cholesterol targets to guide escalation of treatments. Newer therapies, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and small interfering RNA (eg, inclisiran) demonstrated cardiovascular benefit in the general population, but evidence in CKD is limited. Further research on these therapies is needed to define their role in improving cardiovascular and kidney outcomes in people with CKD.

Overview of: : Wilmot EG, Moore P, Sathyapalan T, et al Continuous glucose monitoring versus self-monitoring of blood glucose in individuals with type 2 diabetes: a randomised, multicentre, open-label, superiority trial. Lancet Diabetes Endocrinol 2026;14:463-474. doi:10.1016/S2213-8587(26)00076-8.

The management options for spasticity include non-pharmacological approaches, oral antispasticity drugs, botulinum injections, intrathecal baclofen, neuromodulation techniques and surgery. Effective management necessitates a tailored approach grounded in a comprehensive understanding of pathophysiological mechanisms, disease progression and functional outcomes. Spasticity does not always require treatment. The management should be oriented towards goals which are meaningful for individual patients. This process requires a multidisciplinary team with treatment modalities to reduce spasticity categorised into physical methods, pharmacotherapy, interventional and focal therapies as well as surgical methods.

Commentary on: Rosenstock J, Bailey T, Connery L, et al QWINT-1 trial investigators. Weekly Fixed-Dose Insulin Efsitora in Type 2 Diabetes without Previous Insulin Therapy. N Engl J Med 2025;393:325-35. doi:10.1056/NEJMoa2502796Series Editor: Dr Teck Khong, DTB Associate Editor, Clinical Pharmacology, St George's, University of London, UK.