Know your Microbes - Threat of Multidrug-Resistant Gonorrhoea, -- Gonorrhoea has affected humans for centuries and remains common  Sexually transmitted Infection Worldwide, an estimated 106.1 million cases occur annually. Many patients infected with Gonococcus infections approach unqualified, even chemists and few times a family physician for a treatment, and patients may not  give the proper history and will be subjected to very unscientific approaches with ineffective antibiotics. A major challenge to monitoring emerging antimicrobial resistance of N. gonorrhoea is the substantial decline in capability of laboratories to perform essential gonorrhoea culture techniques required for antibiotic susceptibility testing. Specific diagnosis of infection with N. gonorrhoea can be performed by testing endocervical, vaginal, urethral (men only), or urine specimens. Culture, nucleic acid hybridization tests, and NAATs are available for the detection of genitourinary infection with N. gonorrhoea. Since antibiotics were first used for treatment of gonorrhoea on empirical basis, N. gonorrhoea has progressively developed resistance to the antibiotic drugs prescribed to treat it: sulfonilamides, penicillin, tetracycline, and ciprofloxacin. When bacteria become resistant to an antibiotic, they no longer can be killed by that medicines prescribed; there is no reliable technology that allows for antibiotic susceptibility testing from non-culture specimens; Antimicrobial resistance in Neisseria gonorrhoea may arise by selection of resistant mutants from endogenous flora produced by spontaneous chromosomal mutations, or it can be acquired from other bacteria by plasmid-mediated transfer or DNA transformation and recombination.   Plasmid-mediated resistance to tetracycline and penicillin, and chromosomally mediated resistance to tetracycline, penicillin, and spectinomycin can occur.  As of recently, increased resistance to fluoroquinolones has also been observed.  This can happen by alteration of drug targets, restriction of access to bacterial targets, or both; thus, fluoroquinolone potency is determined by its ability to reach and act on their target enzymes, DNA gyrase and topoisomerase IV, which are both required for bacterial DNA replication . However we are rarely getting a specimen for culturing Gonococcus in majority of our laboratories. In those who fail initial treatment, culture should be done to determine sensitivity to antibiotics. Clinicians many times take decision to treat the disease with accumulated experience, Fluoroquinolones such as ciprofloxacin or Ofloxacin are no longer recommended as first-line therapies for gonococcal infections. Patients infected with N. gonorrhoea frequently are coinfected with C. trachomatis; this finding has led to the recommendation that patients treated for gonococcal infection also be treated routinely with a regimen that is effective against uncomplicated genital C. trachomatis infection .Therapy for gonorrhoea is often given before the susceptibility of the infecting organism is known, the Centres for Disease Control and Prevention recommends that uncomplicated gonorrhoea be treated only with the antibiotic ceftriaxone — given as an injection — in combination with either azithromycin or doxycycline — two antibiotics that are taken orally. Many times the partner of the patient is missed for diagnosis and treatment, one should remember the partner also should undergo testing and treatment for gonorrhoea, even if he or she has no signs or symptoms. Partner receives the same treatment; you give to the infected partner. Even if you've been treated for gonorrhoea, one can be reinfected if his/her partner isn't treated. Untreated gonococcus infection can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility in women and can facilitate transmission of human immunodeficiency virus. Childhood blindness still affects infants born to mothers infected with gonorrhoea, particularly in resource-limited countries. NIAID is studying new ways to treat cephalosporin-resistant infections by using existing antibiotic therapies in combination (i.e., gentamicin and azithromycin vs. Gemifloxacin and azithromycin). Dr.T.V.Rao MD Professor of Microbiology Travancore Medical College, Kollam Kerala India