ABSTRACT
Neisseria gonorrhoeae is the causative agent of gonorrhea, a disease of high morbidity responsible for significant global public health consequences. More than 360,000 cases of infection per year are reported in the United States each year, and many millions of cases occur worldwide [1]. There are three important justifications for the development of a gonococcal vaccine. First, sequelae of mucosal infection in women, including pelvic inflammatory disease (PID) and tubo-ovarian abscess, devastate reproductive health and may become life-threatening [2,3]. Second, depending on the infectiousness of the index case and the susceptibility of the sexual partner, gonococcal infections appear to facilitate the transmission of human immunodeficiency virus type 1 (HIV1) [4,5]. Gonococcal urethritis causes greatly increased shedding of HIV in mucosal secretions and semen [6,7]. Gonococcal infection recruits cells and cytokines capable of enhancing the acquisition of HIV [9], and likely leads to breaks in mucosal integrity, leading to increased virus infectivity [10]. Third, gonococci demonstrate increased resistance to most, if not all, available antibiotic agents [11-15]. Indeed, fluoroquinolone agents can no longer be employed in patients from Asia [16,17].
