Efflux Pumps in Neisseria gonorrhoeae: Contributions to Antimicrobial Resistance and Virulence

This chapter deals with the structure-function relationships, genetics, gene regulation systems, and clinical/biologic significance of efflux pumps expressed by the sexually transmitted human pathogen Neisseria gonorrhoeae. The overarching theme emphasized herein is that bacterial efflux pumps contribute not only to the ability of N. gonorrhoeae to evade many antibiotics in current or past treatment regimens for gonorrhea but they also help this pathogen to evade antimicrobials that contribute to innate host defense during infection. Accordingly, gonococcal drug efflux pumps should be viewed not only in the context of their capacity to negatively impact antimicrobial therapies but in the larger picture as virulence factors that promote survival of N. gonorrhoeae during infection. Based on this hypothesis, we posit that strategies that cripple gonococcal efflux pump activities may prove useful in the design of new therapies, which is of special importance in this era when antibiotic-based treatment options for gonorrhea are dwindling due to mechanisms of bacterial resistance that include the action of drug efflux pumps.