1887
Rapid communication Open Access
Like 0

Abstract

We describe a gonorrhoea case with combined high-level azithromycin resistance and ceftriaxone resistance. In February 2018, a heterosexual male was diagnosed with gonorrhoea in the United Kingdom following sexual intercourse with a locally resident female in Thailand and failed treatment with ceftriaxone plus doxycycline and subsequently spectinomycin. Resistance arose from two mechanisms combining for the first time in a genetic background similar to a commonly circulating strain. Urgent action is essential to prevent further spread.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.27.1800323
2018-07-05
2024-04-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.27.1800323
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/27/eurosurv-23-27-1.html?itemId=/content/10.2807/1560-7917.ES.2018.23.27.1800323&mimeType=html&fmt=ahah

References

  1. Unemo M. Current and future antimicrobial treatment of gonorrhoea - the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infect Dis. 2015;15(1):364.  https://doi.org/10.1186/s12879-015-1029-2  PMID: 26293005 
  2. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.1. Växjö: EUCAST; 2018. Available from: http://www.eucast.org.
  3. Tapsall JW, Ndowa F, Lewis DA, Unemo M. Meeting the public health challenge of multidrug- and extensively drug-resistant Neisseria gonorrhoeae. Expert Rev Anti Infect Ther. 2009;7(7):821-34.  https://doi.org/10.1586/eri.09.63  PMID: 19735224 
  4. De Silva D, Peters J, Cole K, Cole MJ, Cresswell F, Dean G, et al. Whole-genome sequencing to determine transmission of Neisseria gonorrhoeae: an observational study. Lancet Infect Dis. 2016;16(11):1295-303.  https://doi.org/10.1016/S1473-3099(16)30157-8  PMID: 27427203 
  5. Eyre DW, De Silva D, Cole K, Peters J, Cole MJ, Grad YH, et al. WGS to predict antibiotic MICs for Neisseria gonorrhoeae. J Antimicrob Chemother. 2017;72(7):1937-47.  https://doi.org/10.1093/jac/dkx067  PMID: 28333355 
  6. Nakayama S, Shimuta K, Furubayashi K, Kawahata T, Unemo M, Ohnishi M. New Ceftriaxone- and Multidrug-Resistant Neisseria gonorrhoeae Strain with a Novel Mosaic penA Gene Isolated in Japan. Antimicrob Agents Chemother. 2016;60(7):4339-41.  https://doi.org/10.1128/AAC.00504-16  PMID: 27067334 
  7. Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K, et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538-45.  https://doi.org/10.1128/AAC.00325-11  PMID: 21576437 
  8. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613.  https://doi.org/10.1128/CMR.00010-14  PMID: 24982323 
  9. Judson FN, Ehret JM, Handsfield HH. Comparative study of ceftriaxone and spectinomycin for treatment of pharyngeal and anorectal gonorrhea. JAMA. 1985;253(10):1417-9.  https://doi.org/10.1001/jama.1985.03350340069019  PMID: 3155806 
  10. Dowell D, Kirkcaldy RD. Effectiveness of gentamicin for gonorrhoea treatment: systematic review and meta-analysis. Sex Transm Infect. 2012;88(8):589-94.  https://doi.org/10.1136/sextrans-2012-050604  PMID: 22917693 
  11. Ross JD, Harding J, Duley L, Montgomery A, Hepburn T, Tan W, et al. LB1.5 The efficacy and safety of gentamicin for the treatment of genital, pharyngeal and rectal gonorrhoea: a randomised controlled trial. Sex Transm Infect. 2017;93(Suppl 2):A42-3.
  12. Fifer H, Cole M, Hughes G, Padfield S, Smolarchuk C, Woodford N, et al. Sustained transmission of high-level azithromycin-resistant Neisseria gonorrhoeae in England: an observational study. Lancet Infect Dis. 2018;18(5):573-81.  https://doi.org/10.1016/S1473-3099(18)30122-1  PMID: 29523496 
  13. Katz AR, Komeya AY, Kirkcaldy RD, Whelen AC, Soge OO, Papp JR, et al. Cluster of Neisseria gonorrhoeae Isolates With High-level Azithromycin Resistance and Decreased Ceftriaxone Susceptibility, Hawaii, 2016. Clin Infect Dis. 2017;65(6):918-23.  https://doi.org/10.1093/cid/cix485  PMID: 28549097 
  14. Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273-80.  https://doi.org/10.1128/AAC.05760-11  PMID: 22155830 
  15. Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858-60.  https://doi.org/10.1093/jac/dks162  PMID: 22566592 
  16. Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850-1.  https://doi.org/10.1056/NEJMc1408109  PMID: 25372111 
  17. Deguchi T, Yasuda M, Hatazaki K, Kameyama K, Horie K, Kato T, et al. New Clinical Strain of Neisseria gonorrhoeae with Decreased Susceptibility to Ceftriaxone, Japan. Emerg Infect Dis. 2016;22(1):142-4.  https://doi.org/10.3201/eid2201.150868  PMID: 26689442 
  18. Gianecini R, Oviedo C, Stafforini G, Galarza P. Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina. Emerg Infect Dis. 2016;22(6):1139-41.  https://doi.org/10.3201/eid2206.152091  PMID: 27191699 
  19. Lefebvre B, Martin I, Demczuk W, Deshaies L, Michaud S, Labbé AC, et al. Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017. Emerg Infect Dis. 2018;24(2):381-3.  https://doi.org/10.3201/eid2402.171756  PMID: 29131780 
  20. Terkelsen D, Tolstrup J, Johnsen CH, Lund O, Larsen HK, Worning P, et al. Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017. Euro Surveill. 2017;22(42):1273.  https://doi.org/10.2807/1560-7917.ES.2017.22.42.17-00659  PMID: 29067905 
  21. Lahra MM, Martin I, Demczuk W, Jennison AV, Lee KI, Nakayama SI, et al. Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain. Emerg Infect Dis. 2018;24(4):735-43.  https://doi.org/10.3201/eid2404.171873  PMID: 29553335 
  22. Yasuda M, Hatazaki K, Ito S, Kitanohara M, Yoh M, Kojima M, et al. Antimicrobial Susceptibility of Neisseria gonorrhoeae in Japan from 2000 to 2015. Sex Transm Dis. 2017;44(3):149-53. PMID: 28178112 
  23. Yin Y-P, Han Y, Dai X-Q, Zheng HP, Chen SC, Zhu BY, et al. Susceptibility of Neisseria gonorrhoeae to azithromycin and ceftriaxone in China: A retrospective study of national surveillance data from 2013 to 2016. PLoS Med. 2018;15(2):e1002499.  https://doi.org/10.1371/journal.pmed.1002499  PMID: 29408881 
  24. Abrams AJ, Kirkcaldy RD, Pettus K, Fox JL, Kubin G, Trees DL. A Case of Decreased Susceptibility to Ceftriaxone in Neisseria gonorrhoeae in the Absence of a Mosaic Penicillin-Binding Protein 2 (penA) Allele. Sex Transm Dis. 2017;44(8):492-4.  https://doi.org/10.1097/OLQ.0000000000000645  PMID: 28703729 
  25. Fifer H, Natarajan U, Jones L, Alexander S, Hughes G, Golparian D, et al. Failure of Dual Antimicrobial Therapy in Treatment of Gonorrhea. N Engl J Med. 2016;374(25):2504-6.  https://doi.org/10.1056/NEJMc1512757  PMID: 27332921 
  26. Public Health England. UK case of Neisseria gonorrhoeae with high-level resistance to azithromycin and resistance to ceftriaxone acquired abroad. 2018. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/694655/hpr1118_MDRGC.pdf
  27. Australian Department of Health. Multi-drug resistant gonorrhoea in Australia. 2018. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-gonorrhoea.htm
  28. Harris SR, Cole MJ, Spiteri G, Sánchez-Busó L, Golparian D, Jacobsson S, et al. Euro-GASP study group. Public health surveillance of multidrug-resistant clones of Neisseria gonorrhoeae in Europe: a genomic survey. Lancet Infect Dis. 2018;18(7):758-68.  https://doi.org/10.1016/S1473-3099(18)30225-1  PMID: 29776807 
/content/10.2807/1560-7917.ES.2018.23.27.1800323
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error