1887
Perspective Open Access
Like 0

Abstract

has developed resistance to all antimicrobials used to treat gonorrhoea, and the emergence of ceftriaxone-resistant strains threatens the last-line option for empirical treatment. The 2013 Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Action Plan recommended measures to delay the spread of antimicrobial resistance (AMR) in in England. We reviewed trends in gonococcal AMR since then and the experience of implementing the Action Plan’s recommendations to respond to incidents of resistant . Between 2013 and 2019, diagnoses of gonorrhoea in England rose by 128% to 70,922, the largest annual number ever reported. Over this period, isolates have become less susceptible to azithromycin (minimum inhibitory concentration > 0.5 mg/L), increasing from 4.7% in 2016 to 8.7% in 2020; this led to a change in first-line treatment for gonorrhoea in the United Kingdom (UK) from dual therapy (ceftriaxone/azithromycin) to ceftriaxone monotherapy in 2019. We also detected the first global treatment failure for pharyngeal gonorrhoea with a dual-therapy regimen (ceftriaxone/azithromycin), followed by an additional six ceftriaxone-resistant strains. Continued engagement of sexual health clinicians and laboratories with the UK Health Security Agency (UKHSA) is essential for the timely detection of strains with ceftriaxone resistance and to rapidly contain transmission of these strains within England.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2022.27.40.2200057
2022-10-06
2024-12-03
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.40.2200057
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/27/40/eurosurv-27-40-4.html?itemId=/content/10.2807/1560-7917.ES.2022.27.40.2200057&mimeType=html&fmt=ahah

References

  1. World Health Organization. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. Available from: https://apps.who.int/iris/handle/10665/44863
  2. European Centre for Disease Prevention and Control. Response plan to control and manage the threat of multidrug-resistant gonorrhoea in Europe. Stockholm: ECDC; 2012. Available from: https://www.ecdc.europa.eu/en/publications-data/response-plan-control-and-manage-threat-multidrug-resistant-gonorrhoea-europe
  3. Health Protection Agency (HPA). Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) action plan for England and Wales: Informing the public health response. London: HPA; 2013. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20140714113033/http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317138215954
  4. Public Health England (PHE). Sexually transmitted infections and screening for chlamydia in England: 2020 report. London: PHE; 2021. Available from: https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables
  5. Mohammed H, Blomquist P, Ogaz D, Duffell S, Furegato M, Checchi M, et al. 100 years of STIs in the UK: a review of national surveillance data. Sex Transm Infect. 2018;94(8):553-8.  https://doi.org/10.1136/sextrans-2017-053273  PMID: 29654061 
  6. World Health Organisation (WHO). WHO publishes list of bacteria for which new antibiotics are urgently needed. Geneva: WHO; 2017. Available from: https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed
  7. 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).  https://doi.org/10.3201/eid2404.171873  PMID: 29553335 
  8. Chen SC, Yuan LF, Zhu XY, van der Veen S, Yin YP. Sustained transmission of the ceftriaxone-resistant Neisseria gonorrhoeae FC428 clone in China. J Antimicrob Chemother. 2020;75(9):2499-502.  https://doi.org/10.1093/jac/dkaa196  PMID: 32473014 
  9. United Kingdom Health Security Agency (UKHSA). Antimicrobial resistance in Neisseria gonorrhoeae in England and Wales. Key findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2020). Data to June 2021. London: UKHSA; 2021. Available from: https://www.gov.uk/government/publications/gonococcal-resistance-to-antimicrobials-surveillance-programme-grasp-report
  10. Fifer H, Saunders J, Soni S, Sadiq ST, FitzGerald M. 2018 UK national guideline for the management of infection with Neisseria gonorrhoeae. Int J STD AIDS. 2020;31(1):4-15.  https://doi.org/10.1177/0956462419886775  PMID: 31870237 
  11. Public Health England (PHE). Gonococcal resistance to antimicrobials surveillance programme report. Data to October 2016. London: PHE; 2016. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20211103102804/https:/www.gov.uk/government/publications/gonococcal-resistance-to-antimicrobials-surveillance-programme-grasp-report
  12. Public Health England (PHE). Resistance alert: high-level azithromycin resistance in Neisseria gonorrhoeae. London: PHE; 2016. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/518934/HL-Azithromycin-resistant-Neisseria-gonorrhoea_20151110.pdf
  13. 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 
  14. Public Health England (PHE). Antimicrobial resistance in Neisseria gonorrhoeae in England and Wales. Key findings from the Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP 2019). Data to June 2020. London: PHE; 2020. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20211103102804/https://www.gov.uk/government/publications/gonococcal-resistance-to-antimicrobials-surveillance-programme-grasp-report
  15. Smolarchuk C, Wensley A, Padfield S, Fifer H, Lee A, Hughes G. Persistence of an outbreak of gonorrhoea with high-level resistance to azithromycin in England, November 2014‒May 2018. Euro Surveill. 2018;23(23):1800287.  https://doi.org/10.2807/1560-7917.ES.2018.23.23.1800287  PMID: 29897041 
  16. Smolarchuk C, Mohammed H, Furegato M, Town K, Fifer H, Wilson J, et al. Just Google it! Impact of media coverage of an outbreak of high-level azithromycin-resistant Neisseria gonorrhoeae on online searches, and attendances, testing and diagnoses at sexual health clinics in England between 2015 and 2016: an interrupted time series analysis using surveillance data. Sex Transm Infect. 2019;95(8):594-601.  https://doi.org/10.1136/sextrans-2019-053986  PMID: 31040249 
  17. 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 
  18. Eyre DW, Sanderson ND, Lord E, Regisford-Reimmer N, Chau K, Barker L, et al. Gonorrhoea treatment failure caused by a Neisseria gonorrhoeae strain with combined ceftriaxone and high-level azithromycin resistance, England, February 2018. Euro Surveill. 2018;23(27):1800323.  https://doi.org/10.2807/1560-7917.ES.2018.23.27.1800323  PMID: 29991383 
  19. European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: Extensively drug-resistant (XDR) Neisseria gonorrhoeae in the United Kingdom and Australia. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-extensively-drug-resistant-xdr-neisseria-gonorrhoeae-united
  20. European Centre for Disease Prevention and Control (ECDC). Response plan to control and manage the threat of multi- and extensively drug-resistant gonorrhoea in Europe. Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/en/publications-data/response-plan-control-and-manage-threat-multi-and-extensively-drug-resistant
  21. Eyre DW, Town K, Street T, Barker L, Sanderson N, Cole MJ, et al. Detection in the United Kingdom of the Neisseria gonorrhoeae FC428 clone, with ceftriaxone resistance and intermediate resistance to azithromycin, October to December 2018. Euro Surveill. 2019;24(10):1900147.  https://doi.org/10.2807/1560-7917.ES.2019.24.10.1900147  PMID: 30862336 
  22. Nettleton WD, Kent JB, Macomber K, Brandt MG, Jones K, Ridpath AD, et al. Notes from the field: ongoing cluster of highly related disseminated gonococcal infections - southwest Michigan, 2019. MMWR Morb Mortal Wkly Rep. 2020;69(12):353-4.  https://doi.org/10.15585/mmwr.mm6912a5  PMID: 32214085 
  23. Merrick R, Pitt R, Enayat Q, Day M, Thorn L, Mohammed H, et al. National surveillance of disseminated gonococcal infection: preliminary findings from cross-sectional survey data in England, 2016-21. Lancet. 2021;398(S65):S65.  https://doi.org/10.1016/S0140-6736(21)02608-8 
/content/10.2807/1560-7917.ES.2022.27.40.2200057
Loading

Data & Media loading...

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