The Roadblocks in Developing a Gonococcal Vaccine and Reasons for Optimism
Lee M. Wetzler
from: Pathogenic Neisseria: Genomics, Molecular Biology and Disease Intervention (Edited by: John K. Davies and Charlene M. Kahler). Caister Academic Press, U.K. (2014)
The search for an effective vaccine to prevent gonococcal infections has been an ongoing endeavor for over three decades. Gonococcal diseases, including endometritis, pelvic inflammatory disease (PID), and their sequelae (ectopic pregnancies and infertility) in women, and urethritis and disseminated gonococcal infection in both men and women, remain one of the major reportable sexually transmitted diseases (STD) in the country (approximately 300,000 cases a year, 100.8 cases per 100,000 people). Moreover, it has been shown that concurrent inflammatory STDs, and particularly gonococcal disease, can enhance HIV replication and transmission. Of equal or greater concern is the currently rising incidence of gonococcal antibiotic resistance. Over the past decade, disease-associated gonococcal strains have developed resistance to penicillin and quinolones. Most alarming is the recent report out of Japan that pathogenic strains of gonococci have developed high-level resistance to ceftriaxone. The implication of this cannot be over-emphasized since cephalosporins are the only remaining class of antibiotics to treat this infection. The development of an effective gonococcal vaccine has many roadblocks including the dearth of immune correlates of protection; mainly due to the lack of adequate animal models. In order to aid in developing an efficacious anti-gonococcal vaccine, it is important to understand the immune response to this organism in humans, including patients with disease and their infected and uninfected sexual contacts. The purpose of this review is to describe the history of gonococcal vaccine development, previous immune studies and vaccine trials and the current development of new animal models and potential new vaccine candidates read more ...