BACKGROUNDNeisseria gonorrhoeae (NG), the pathogen causing the sexually transmitted infection (STI) gonorrhoea, shows increasing antimicrobial resistance threatening recommended treatments.AIMWe examined temporal trends in antibiotic susceptibility of NG isolates in Germany and possible shifts in sexual networks.METHODSWe analysed annual data from the German antimicrobial resistance sentinel surveillance programme Go-Surv-AMR (2014-2023). Isolates were tested by E-test for phenotypic susceptibility to azithromycin (AZM), ceftriaxone (CRO) and ciprofloxacin (CIP) to determine minimum inhibitory concentrations (MIC). We described patient demographics and calculated MIC metrics by year, sex, age group and specimen type. We assessed differences in yearly MIC distributions using Kolmogorov-Smirnov tests and analysed temporal trends by fitting beta distributions to log-transformed MIC by antibiotic and epidemiological group.RESULTSWe collected 5,421 NG isolates from across Germany, primarily from males (n = 4,704) and from urethral specimens (n = 4,060). From 2016 to 2023, median AZM MIC nearly quadrupled in female and male isolates (0.12-0.45 mg/L). Median CRO MIC remained low overall (≤ 0.009 mg/L) but increased significantly in males in 2022-2023, especially in extragenital/screening isolates. Median CIP MIC increased (0.003-0.0057 mg/L), most pronounced in male extragenital/screening isolates.CONCLUSIONAcross the examined decade, NG showed subtle increases in MIC in extragenital/screening isolates from males, possibly reflecting decreasing antibiotic susceptibility in groups that regularly undergo STI screening. Rising AZM MIC suggests early spread of resistant strains. This highlights the need for continued surveillance, consistent susceptibility testing, targeted education for vulnerable groups, promotion of condom use, and potential vaccination.

Neisseria meningitidis is an uncommon cause of genitourinary infection, and chronic prostatitis caused by this organism has rarely been reported. A 34-year-old man presented with recurrent dysuria and urethral discharge after oral sexual exposure. Initially misdiagnosed as gonococcal urethritis, the patient achieved only partial improvement after empirical therapy. Culture of midstream urine and expressed prostatic secretions, confirmed by biochemical testing,MALDI-TOF MS and 16S rDNA sequencing, identified N. meningitidis. Targeted antimicrobial therapy resulted in clinical and microbiological resolution. This case highlights the importance of accurate pathogen identification in recurrent urethritis and prostatitis.

Background and Objectives: Antimicrobial resistance in Neisseria gonorrheae threatens the effectiveness of empirical gonorrhoea treatment. Although global surveillance evidence is increasingly available, resistance data are not consistently reported separately for men with urethral or urogenital infection. This review evaluated antibiotic-specific resistance in N. gonorrhoeae isolates from this clinically defined population and examined the geographic and reporting limitations of the available evidence. Materials and Methods: PubMed, Scopus, ScienceDirect, Google Scholar, and relevant WHO GASP/EGASP resources were searched from inception to [updated search date]. Eligible observational or surveillance studies reported categorical resistance classifications or extractable antibiotic-specific resistant counts and denominators for male urethral or urogenital isolates. Antibiotic-specific proportions were synthesized using random-effects meta-analysis where pooling was considered appropriate. Sparse-event outcomes were additionally evaluated using study-specific estimates and aggregate resistant/tested counts. Certainty of evidence was assessed using the GRADE framework adapted for prevalence outcomes. Results: Six studies met the eligibility criteria, including the 2025 multinational EGASP study. Cefixime resistance was reported in 748 of 13,154 isolates, corresponding to an aggregate proportion of 5.69%; however, the random-effects estimate was unstable because three studies reported no resistant isolates and events were concentrated in two large datasets. Ceftriaxone resistance varied from 0% to 5.17%, with a pooled estimate of 0.32% (95% CI 0.05-2.15; I[2] = 97.8%). Resistance was high but heterogeneous for ciprofloxacin (71.84%, 95% CI 7.53-98.77; I[2] = 97.3%) and penicillin (62.47%, 95% CI 36.87-82.58; I[2] = 98.1%). Spectinomycin resistance was 2.57% (95% CI 1.58-4.16; I[2] = 0%), while azithromycin resistance was 6.38% (95% CI 4.38-9.21; I[2] = 94.9%). Certainty of evidence was very low for all outcomes. Conclusions: Evidence specifically reporting resistance in male urethral or urogenital N. gonorrhoeae isolates remains limited and geographically uneven. Contemporary EGASP data demonstrate that ceftriaxone resistance is not uniformly low across surveillance settings. The pooled estimates should be interpreted as exploratory summaries rather than current global prevalence values or an independent basis for treatment selection. Standardized reporting of sex, anatomical site, breakpoints, MIC distributions, and resistant/tested counts is needed to improve future surveillance synthesis.

Persistent urethral burning without identifiable infection represents a diagnostically challenging condition in male urology and may lead to repeated empirical treatment with limited benefit. We report the case of a 35-year-old man who experienced isolated urethral burning for approximately six years after an initial urinary tract infection. Despite repeated evaluations and multiple conventional treatments, his symptoms persisted. Laboratory investigations, including urinalysis, urine culture, gonococcal smear examination, and prostatic fluid analysis, showed no evidence of active infection or clinically significant prostatic inflammation. Transabdominal pelvic ultrasonography revealed only mild nonspecific prostatic changes without major structural abnormalities. Given the chronic refractory symptoms and negative diagnostic findings, an integrative symptom-oriented management strategy incorporating a modified Gancao Xiexin decoction was initiated. The patient reported gradual improvement, with the visual analogue scale score decreasing from 8 at baseline to 4 after one week and to 0 after two months. Anxiety, sleep quality, bowel habits, and overall well-being also improved, and no adverse effects or symptom recurrence were reported during follow-up. This case highlights the diagnostic uncertainty associated with persistent urethral burning without identifiable infection and suggests that noninfectious pain-related mechanisms may deserve consideration in selected patients. The observed improvement should be interpreted as a temporal association rather than evidence of therapeutic efficacy, and further studies are needed to clarify the underlying mechanisms and evaluate integrative management approaches for chronic unexplained urethral pain conditions.

We assessed the in vitro and in vivo efficacy of nitrofurantoin in a panel of Neisseria gonorrhoeae strains. Four N. gonorrhoeae strains-three WHO reference strains (WHO U, WHO P, WHO V) and a clinical isolate from a patient with symptomatic urethritis (25566) were tested for nitrofurantoin susceptibility using E-tests on GC agar. To investigate resistance emergence, each strain was serially passaged on GC agar with a nitrofurantoin gradient E-tests for ten consecutive days. Nitrofurantoin-resistant isolates (n = 3) underwent whole genome sequencing (WGS) to identify resistance-associated mutations. In vivo efficacy was evaluated using the Galleria mellonella infection model: larvae were infected with N. gonorrhoeae 25566 and treated with nitrofurantoin at 5 mg/kg or 50 mg/kg. Larval survival and melanization were monitored up to 48 h. We found that the nitrofurantoin MICs were between 0.5 and 24 µg/ml. WGS identified a canonical point mutation at nfsB at position 155 (GàA) for WHO U-S3 isolate, whereas WHO P-S2, WHO V-S4, showed no new nfsB point mutations despite MIC increases. A dose of 50 mg/kg was effective against N. gonorrhoeae in the G. mellonella infection model. Constant exposure to nitrofurantoin over 10 days resulted in increases in MIC in three of four strains.

Neisseria gonorrhoeae conjunctivitis is rare in adults but may rapidly progress to vision-threatening complications. Peripheral ulcerative keratitis (PUK) is an unusual and severe manifestation. A 42-year-old male presented with bilateral ocular pain, swelling, and profuse purulent discharge for 15 days, leading to inability to open his eyes. History revealed recent urethral discharge and multiple sexual contacts. Ocular examination showed severe conjunctival chemosis and peripheral corneal thinning with descemetocele formation. Gram stain of conjunctival swabs demonstrated intracellular gram-negative diplococci. Serology revealed positive VDRL and TPHA (late latent syphilis). HIV and Chlamydia trachomatis testing were unavailable. The patient received intravenous ceftriaxone 1 g twice daily, oral doxycycline, and topical fortified antibiotics. Due to progressive corneal thinning, bilateral amniotic membrane grafting with perilimbal conjunctival excision and bandage contact lens placement was performed. Syphilis was treated with three weekly doses of benzathine penicillin G. At 6 weeks, vision improved to 6/9 bilaterally with healed ulcers and clear corneas. Gonococcal conjunctivitis in adults can rapidly progress to peripheral ulcerative keratitis. Early diagnosis, broad STI screening, systemic therapy, and timely surgical intervention are critical for preserving vision.

Sneathia species are emerging pathogens associated with adverse gynaecologic, obstetric and neonatal sequelae, including bacterial vaginosis, preterm birth, chorioamnionitis, non-gonococcal urethritis and HPV-mediated cervical carcinogenesis. Yet, their pathogenicity is poorly understood due to their fastidious nature. Here, we conducted infection assays using multiple strains of Sneathia vaginalis and Sneathia sanguinegens to evaluate host responses in an in vitro 3D organotypic model of the human cervix. We profiled a broad array of proteins, including antimicrobial peptides, cytokines, growth factors, mucins, matrix metalloproteinases and proteins related to apoptosis and cellular stress. Both Sneathia species induced similar pro-inflammatory signatures. Notably, all strains robustly induced IL-6 and IL-8/CXCL8 (P from 0.02 to <0.0001), which are clinical markers associated with preterm birth, vaginal dysbiosis and cervical carcinogenesis. Most strains also induced the two chemokines IP-10/CXCL10 and MIP-3α/CCL20. Conversely, no significant induction of matrix metalloproteinases or apoptosis-related proteins was observed. Furthermore, co-infection with both species elicited similar cytokine patterns with no synergistic effects observed. Collectively, investigation of multiple strains confirms that both Sneathia species trigger a conserved immune-mediated response. This reveals a shared pathogenic mechanism that represents a potential pathway toward adverse gynaecologic and obstetric outcomes.