Evidências e repercussões da resistência aos medicamentos em infecções sexualmente transmissíveis
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Publicado
Apr 30, 2025
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Resumo
Objetivo: Descrever evidências científicas acerca das tendências e repercussões clínicas inerentes à ocorrência de resistência aos medicamentos para o tratamento de infecções sexualmente transmissíveis. Métodos: Foi utilizado para seleção dos estudos o modelo PRISMA com a inclusão de pesquisas publicadas no período de 2018 a 2023 e excluídos aqueles que não responderam à pergunta norteadora do estudo. Resultados: As principais ISTs associadas à problemática foram gonorreia, citada em 56% dos artigos, seguida por uretrite e cervicite em 44%, e clamídia em 8%. As principais classes de medicamentos associadas à resistência bacteriana em ISTs foram os macrolídeos (40%), cefalosporinas (20%) e fluoroquinolonas (16%). Umas das principais tendências detectadas foi aumento na propagação da resistência, principalmente para Neisseria gonorrhoeae. Considerações finais: Em conjunto, os dados evidenciam a crescente ameaça global de patógenos causadores de ISTs resistentes aos antimicrobianos, projetadas para causar um significativo aumento nas taxas de morbidade, mortalidade e, assim, se faz primordial intervenções inovadoras e coordenadas para preservar a eficácia dos tratamentos e atender às metas globais de saúde pública. Além disso, o tratamento com base em evidências microbiológicas e racional, bem como a implementação de programas eficazes para rastreio e vigilância local e global, são cruciais.
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Como Citar
RibeiroE. A., FrançaJ. S., LealL. M., & SouzaM. R. A. de. (2025). Evidências e repercussões da resistência aos medicamentos em infecções sexualmente transmissíveis. Revista Eletrônica Acervo Saúde, 25, e18384. https://doi.org/10.25248/reas.e18384.2025
Seção
Revisão Bibliográfica
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Referências
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2. BEALE MA, et al. Genomic epidemiology of syphilis reveals independent emergence of macrolide resistance across multiple circulating lineages. Nat Commun [Internet]. 2019; 10(1): 3255.
3. BERÇOT B, et al. High prevalence and high rate of antibiotic resistance of Mycoplasma genitalium infections in men who have sex with men: A substudy of the ANRS IPERGAY pre-exposure prophylaxis trial. Clin Infect Dis [Internet]. 2021; 73(7): 2127–33.
4. DE ASSIS LV, et al. Chlamydia Trachomatis e o risco de doença inflamatória pélvica evoluindo para quadro de infertilidade feminina: uma revisão bibliográfica. Acervo Científico [Internet]. 2021; 19: 5669.
5. FIFER H, et al. Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: Findings from a national sentinel surveillance pilot in England. Sex Transm Dis [Internet]. 2021; 48(12): 951–4.
6. FLETCHER-LARTEY S, et al. Trends in antimicrobial resistance patterns in Neisseria gonorrhoeae in Australia and New Zealand: A meta-analysis and systematic review. Antibiotics (Basel) [Internet]. 2019; 8(4): 191.
7. FRACAROLLI IFL, et al. Colonização bacteriana e resistência antimicrobiana em trabalhadores de saúde: revisão integrativa. Acta Paul Enferm [Internet]. 2017; 30(6): 651–7.
8. GUO C, et al. Transmitted drug resistance in antiretroviral therapy-naive persons with acute/early/primary HIV infection: A systematic review and meta-analysis. Front Pharmacol [Internet]. 2021; 12.
9. IWUJI C, et al. A systematic review of antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium in sub-Saharan Africa. J Antimicrob Chemother [Internet]. 2022; 77(8): 2074–93.
10. KHOSROPOUR CM, et al. High prevalence of vaginal and rectal Mycoplasma genitalium macrolide resistance among female sexually transmitted disease clinic patients in Seattle, Washington. Sex Transm Dis [Internet]. 2020; 47(5): 321–5.
11. LAI C-C, et al. Increased antimicrobial resistance during the COVID-19 pandemic. Int J Antimicrob Agents [Internet]. 2021; 57(4): 106324.
12. LEE H, et al. Emergence and spread of cephalosporin-resistantNeisseria gonorrhoeaewith mosaicpenAalleles, South Korea, 2012–2017. Emerg Infect Dis [Internet]. 2019; 25(3): 416–24.
13. LIN EY, et al. Epidemiology, treatments, and vaccine development for antimicrobial-resistant Neisseria gonorrhoeae: Current strategies and future directions. Drugs [Internet]. 2021; 81(10): 1153–69.
14. LU Z, et al. Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis. Yale J Biol Med. 2022; 95(4): 465–78.
15. MABONGA E, et al. Complete ciprofloxacin resistance in gonococcal isolates in an urban Ugandan clinic: findings from a cross-sectional study. Int J STD AIDS [Internet]. 2019; 30(3): 256–63.
16. MARTENS L, et al. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017. Emerg Infect Dis [Internet]. 2019; 25(7): 1297–303.
17. MELENDEZ JH, et al. Retrospective analysis of Ugandan men with urethritis reveals Mycoplasma genitalium and associated macrolide resistance. Microbiol Spectr [Internet]. 2022; 10(2).
18. MELNYK BM e FINEOUT-OVERHOLT E. Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Wolters Kluwer Health. 10–16
19. MITCHELL HD, et al. Prevalence and risk factors of bacterial enteric pathogens in men who have sex with men: A cross-sectional study at the UK’s largest sexual health service. J Infect [Internet]. 2023; 86(1): 33–40.
20. MOJICA MF, et al. The urgent need for metallo-β-lactamase inhibitors: an unattended global threat. Lancet Infect Dis [Internet]. 2022; 22(1): 28–34.
21. MONDEJA BA, et al. Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: an underestimated health problem. BMC Infect Dis [Internet]. 2018; 18(1).
22. NAKKU-JOLOBA E, et al. Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda. Afr Health Sci [Internet]. 2022; 22(3): 62–71.
23. PASCOAL IL, et al. Trichomonas vaginalis como Co-Fator na propagação do HIV em mulheres: uma revisão de literatura Braz. J. Develop. [Internet]. 2021; 7(5): 52660-73.
24. PINTO VM, et al. Fatores associados às infecções sexualmente transmissíveis: inquérito populacional no município de São Paulo, Brasil. Cien Saude Colet [Internet]. 2018; 23(7): 2423–32.
25. PITT R, et al. Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population. Sex Transm Infect [Internet]. 2020; 96(6): 464–8.
26. POLLY M, et al. Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil. Am J Infect Control [Internet]. 2022; 50(1): 32–8.
27. SALMERÓN P, et al. Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study. J Antimicrob Chemother [Internet]. 2021; 76(6): 1523–31.
28. SANDOVAL MM, et al. Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review. J Antimicrob Chemother [Internet]. 2023; 78(6): 1322–36.
29. SCHAEFFER J, et al. Rifampicin resistance associated with rpoB mutations in Neisseria gonorrhoeae clinical strains isolated in Austria, 2016 to 2020. Microbiol Spectr [Internet]. 2022; 10(3).
30. SHANNON CL e KLAUSNER JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr [Internet]. 2018; 30(1): 137–43.
31. SILVA EFO, et al. Fatores associados ao aumento de infecções sexualmente transmissíveis no público idoso. Revista Eletrônica Acervo Saúde, 2023; 23(3): 11813.
32. SIMÕES LA, et al. Fatores associados à coinfecção HIV/sífilis no início da terapia antirretroviral. Rev Saúde Publica. 2022; 56: 59.
33. SUTHERLAND SBN. Debate Pack O’Neill. Review into Antibiotic Resistance. House of Commons; 2017; (1): 1–41.
34. SWEENEY EL, et al. Levels of Mycoplasma genitalium antimicrobial resistance differ by both region and gender in the state of Queensland, Australia: Implications for treatment guidelines. J Clin Microbiol [Internet]. 2019; 57(3).
35. TEIXEIRA LG, et al. O perfil epidemiológico da AIDS no Brasil. Braz J Hea Rev [Internet]. 2022; 5(1): 1980–92.
36. TIEN V, et al. Antimicrobial resistance in sexually transmitted infections. J Travel Med [Internet]. 2020; 27(1).
37. UNEMO M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect [Internet]. 2018; 24(5): 533–9.
38. UNEMO M, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis [Internet]. 2017; 17(8): 235–79.
39. VICENTE CMM, et al. International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review. Travel Med Infect Dis [Internet]. 2022; 49(102401): 102401.
40. VISSER M, et al. Trends and regional variations of gonococcal antimicrobial resistance in the Netherlands, 2013 to 2019. Euro Surveill [Internet]. 2022; 27(34).
41. WILLIE B, et al. The prevalence of antimicrobial resistant Neisseria gonorrhoeae in Papua New Guinea: A systematic review and meta-analysis. Int J Environ Res Public Health [Internet]. 2022; 19(3): 1520.
42. WORLD HEALTH ORGANIZATION. HIV drug resistance report, 2021.
2. BEALE MA, et al. Genomic epidemiology of syphilis reveals independent emergence of macrolide resistance across multiple circulating lineages. Nat Commun [Internet]. 2019; 10(1): 3255.
3. BERÇOT B, et al. High prevalence and high rate of antibiotic resistance of Mycoplasma genitalium infections in men who have sex with men: A substudy of the ANRS IPERGAY pre-exposure prophylaxis trial. Clin Infect Dis [Internet]. 2021; 73(7): 2127–33.
4. DE ASSIS LV, et al. Chlamydia Trachomatis e o risco de doença inflamatória pélvica evoluindo para quadro de infertilidade feminina: uma revisão bibliográfica. Acervo Científico [Internet]. 2021; 19: 5669.
5. FIFER H, et al. Frequency and correlates of Mycoplasma genitalium antimicrobial resistance mutations and their association with treatment outcomes: Findings from a national sentinel surveillance pilot in England. Sex Transm Dis [Internet]. 2021; 48(12): 951–4.
6. FLETCHER-LARTEY S, et al. Trends in antimicrobial resistance patterns in Neisseria gonorrhoeae in Australia and New Zealand: A meta-analysis and systematic review. Antibiotics (Basel) [Internet]. 2019; 8(4): 191.
7. FRACAROLLI IFL, et al. Colonização bacteriana e resistência antimicrobiana em trabalhadores de saúde: revisão integrativa. Acta Paul Enferm [Internet]. 2017; 30(6): 651–7.
8. GUO C, et al. Transmitted drug resistance in antiretroviral therapy-naive persons with acute/early/primary HIV infection: A systematic review and meta-analysis. Front Pharmacol [Internet]. 2021; 12.
9. IWUJI C, et al. A systematic review of antimicrobial resistance in Neisseria gonorrhoeae and Mycoplasma genitalium in sub-Saharan Africa. J Antimicrob Chemother [Internet]. 2022; 77(8): 2074–93.
10. KHOSROPOUR CM, et al. High prevalence of vaginal and rectal Mycoplasma genitalium macrolide resistance among female sexually transmitted disease clinic patients in Seattle, Washington. Sex Transm Dis [Internet]. 2020; 47(5): 321–5.
11. LAI C-C, et al. Increased antimicrobial resistance during the COVID-19 pandemic. Int J Antimicrob Agents [Internet]. 2021; 57(4): 106324.
12. LEE H, et al. Emergence and spread of cephalosporin-resistantNeisseria gonorrhoeaewith mosaicpenAalleles, South Korea, 2012–2017. Emerg Infect Dis [Internet]. 2019; 25(3): 416–24.
13. LIN EY, et al. Epidemiology, treatments, and vaccine development for antimicrobial-resistant Neisseria gonorrhoeae: Current strategies and future directions. Drugs [Internet]. 2021; 81(10): 1153–69.
14. LU Z, et al. Global status of Azithromycin and Erythromycin Resistance Rates in Neisseria gonorrhoeae: A Systematic Review and Meta-analysis. Yale J Biol Med. 2022; 95(4): 465–78.
15. MABONGA E, et al. Complete ciprofloxacin resistance in gonococcal isolates in an urban Ugandan clinic: findings from a cross-sectional study. Int J STD AIDS [Internet]. 2019; 30(3): 256–63.
16. MARTENS L, et al. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017. Emerg Infect Dis [Internet]. 2019; 25(7): 1297–303.
17. MELENDEZ JH, et al. Retrospective analysis of Ugandan men with urethritis reveals Mycoplasma genitalium and associated macrolide resistance. Microbiol Spectr [Internet]. 2022; 10(2).
18. MELNYK BM e FINEOUT-OVERHOLT E. Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia, PA: Wolters Kluwer Health. 10–16
19. MITCHELL HD, et al. Prevalence and risk factors of bacterial enteric pathogens in men who have sex with men: A cross-sectional study at the UK’s largest sexual health service. J Infect [Internet]. 2023; 86(1): 33–40.
20. MOJICA MF, et al. The urgent need for metallo-β-lactamase inhibitors: an unattended global threat. Lancet Infect Dis [Internet]. 2022; 22(1): 28–34.
21. MONDEJA BA, et al. Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: an underestimated health problem. BMC Infect Dis [Internet]. 2018; 18(1).
22. NAKKU-JOLOBA E, et al. Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda. Afr Health Sci [Internet]. 2022; 22(3): 62–71.
23. PASCOAL IL, et al. Trichomonas vaginalis como Co-Fator na propagação do HIV em mulheres: uma revisão de literatura Braz. J. Develop. [Internet]. 2021; 7(5): 52660-73.
24. PINTO VM, et al. Fatores associados às infecções sexualmente transmissíveis: inquérito populacional no município de São Paulo, Brasil. Cien Saude Colet [Internet]. 2018; 23(7): 2423–32.
25. PITT R, et al. Antimicrobial resistance in Mycoplasma genitalium sampled from the British general population. Sex Transm Infect [Internet]. 2020; 96(6): 464–8.
26. POLLY M, et al. Impact of the COVID-19 pandemic on the incidence of multidrug-resistant bacterial infections in an acute care hospital in Brazil. Am J Infect Control [Internet]. 2022; 50(1): 32–8.
27. SALMERÓN P, et al. Neisseria gonorrhoeae antimicrobial resistance in Spain: a prospective multicentre study. J Antimicrob Chemother [Internet]. 2021; 76(6): 1523–31.
28. SANDOVAL MM, et al. Antimicrobial resistance of Neisseria gonorrhoeae in Latin American countries: a systematic review. J Antimicrob Chemother [Internet]. 2023; 78(6): 1322–36.
29. SCHAEFFER J, et al. Rifampicin resistance associated with rpoB mutations in Neisseria gonorrhoeae clinical strains isolated in Austria, 2016 to 2020. Microbiol Spectr [Internet]. 2022; 10(3).
30. SHANNON CL e KLAUSNER JD. The growing epidemic of sexually transmitted infections in adolescents: a neglected population. Curr Opin Pediatr [Internet]. 2018; 30(1): 137–43.
31. SILVA EFO, et al. Fatores associados ao aumento de infecções sexualmente transmissíveis no público idoso. Revista Eletrônica Acervo Saúde, 2023; 23(3): 11813.
32. SIMÕES LA, et al. Fatores associados à coinfecção HIV/sífilis no início da terapia antirretroviral. Rev Saúde Publica. 2022; 56: 59.
33. SUTHERLAND SBN. Debate Pack O’Neill. Review into Antibiotic Resistance. House of Commons; 2017; (1): 1–41.
34. SWEENEY EL, et al. Levels of Mycoplasma genitalium antimicrobial resistance differ by both region and gender in the state of Queensland, Australia: Implications for treatment guidelines. J Clin Microbiol [Internet]. 2019; 57(3).
35. TEIXEIRA LG, et al. O perfil epidemiológico da AIDS no Brasil. Braz J Hea Rev [Internet]. 2022; 5(1): 1980–92.
36. TIEN V, et al. Antimicrobial resistance in sexually transmitted infections. J Travel Med [Internet]. 2020; 27(1).
37. UNEMO M, et al. Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 2016. Clin Microbiol Infect [Internet]. 2018; 24(5): 533–9.
38. UNEMO M, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis [Internet]. 2017; 17(8): 235–79.
39. VICENTE CMM, et al. International travels and transmission of multidrug resistant Neisseria gonorrhoeae in Europe: A systematic review. Travel Med Infect Dis [Internet]. 2022; 49(102401): 102401.
40. VISSER M, et al. Trends and regional variations of gonococcal antimicrobial resistance in the Netherlands, 2013 to 2019. Euro Surveill [Internet]. 2022; 27(34).
41. WILLIE B, et al. The prevalence of antimicrobial resistant Neisseria gonorrhoeae in Papua New Guinea: A systematic review and meta-analysis. Int J Environ Res Public Health [Internet]. 2022; 19(3): 1520.
42. WORLD HEALTH ORGANIZATION. HIV drug resistance report, 2021.