Expert Consensus on Controlled Human Infection Studies for Gonorrhoea.

BACKGROUND: Gonorrhoea, a bacterial sexually transmitted infection caused by Neisseria gonorrhoeae, is a major global public health concern due to rising incidence and increasing antimicrobial resistance. Absence of a licensed vaccine and limitations of animal models have impeded progress in the understanding of pathogenesis, immunity and development of novel therapeutics and vaccines. Controlled human infection studies (CHIS) offer a powerful approach to accelerate vaccine and antimicrobial development and improve understanding of host-pathogen interactions. METHODS: An international, multidisciplinary stakeholder workshop was convened in Oxford, UK (March 2025) to review current gonorrhoea CHIS activity, define research priorities and establish consensus standards for future studies through structured discussion. RESULTS: Consensus highlighted the continued value of CHIS with well-characterised strains such as FA1090, while supporting careful selection and characterisation of novel strains. Standardised, risk-based approaches to inoculum manufacture and quality assurance were recommended to enhance reproducibility and scalability. Expansion of CHIS to include additional anatomical sites and novel populations, including individuals with female reproductive anatomy, was identified as scientifically valuable but requiring careful ethical and safety evaluation. CHIS were recognised as uniquely positioned to advance vaccine and antimicrobial development by enabling early efficacy assessment, identification of correlates of protection and optimisation of treatment and prevention strategies. CONCLUSIONS: Gonorrhoea CHIS are an underutilised but valuable research tool with potential to accelerate translational research against gonorrhoea. With robust ethical oversight, community engagement and international collaboration, expanded and harmonised CHIS could substantially advance prevention and treatment strategies.