Figure 1.

Comparison of antibiotic and anti-virulence approaches for treatment of N. gonorrhoeae. (A) Potential route for antibiotic resistance development in N. gonorrhoeae (pink diplococci). Antibiotics also affect the microbiome (Lactobacilli: grey rods; commensal Neisseria: purple circles), forcing resistance determinants to evolve (blue outline). This resistance can then develop in N. gonorrhoeae through gene acquisition via natural transformation (blue arrow) or spontaneous mutation. While antibiotic treatment may assist PMNs and macrophages (yellow cells) in killing the bacteria, the prescribed concentration may not be effective, resulting in proliferation of antibiotic resistant bacteria. (B) Use of AVTs (green outline) enables PMNs and macrophages to kill the gonococci without affecting the microbiome.