World Health Organization Global Gonococcal Antimicrobial Surveillance Program (WHO GASP): review of new data and evidence to inform international collaborative actions and research efforts

Abstract

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a serious public health problem, compromising the management and control of gonorrhoea globally. Resistance in N. gonorrhoeae to ceftriaxone, the last option for first-line empirical monotherapy of gonorrhoea, has been reported from many countries globally, and sporadic failures to cure especially pharyngeal gonorrhoea with ceftriaxone monotherapy and dual antimicrobial therapies (ceftriaxone plus azithromycin or doxycycline) have been confirmed in several countries. In 2018, the first gonococcal isolates with ceftriaxone resistance plus high-level azithromycin resistance were identified in England and Australia. The World Health Organization (WHO) Global Gonococcal Antimicrobial Surveillance Program (GASP) is essential to monitor AMR trends, identify emerging AMR and provide evidence for refinements of treatment guidelines and public health policy globally. Herein we describe the WHO GASP data from 67 countries in 2015-16, confirmed gonorrhoea treatment failures with ceftriaxone with or without azithromycin or doxycycline, and international collaborative actions and research efforts essential for the effective management and control of gonorrhoea. In most countries, resistance to ciprofloxacin is exceedingly high, azithromycin resistance is present and decreased susceptibility or resistance to ceftriaxone has emerged. Enhanced global collaborative actions are crucial for the control of gonorrhoea, including improved prevention, early diagnosis, treatment of index patient and partner (including test-of-cure), improved and expanded AMR surveillance (including surveillance of antimicrobial use and treatment failures), increased knowledge of correct antimicrobial use and the pharmacokinetics and pharmacodynamics of antimicrobials and effective drug regulations and prescription policies (including antimicrobial stewardship). Ultimately, rapid, accurate and affordable point-of-care diagnostic tests (ideally also predicting AMR and/or susceptibility), new therapeutic antimicrobials and, the only sustainable solution, gonococcal vaccine(s) are imperative.

Fig. 1.

Percentage of isolates with decreased susceptibility or resistance (DS/R) to ceftriaxone reported to the World Health Organization Global Gonococcal Antimicrobial Surveillance Program in 2016 (for Cyprus, Kenya and Panama, data were only available from 2015). Note, the areas in grey are disputed territories (e.g. Western Sahara, Jammu and Kashmir) and no antimicrobial resistance data were available from these regions.

Fig. 2.

Percentage of isolates with decreased susceptibility or resistance (DS/R) to cefixime reported to the World Health Organization Global Gonococcal Antimicrobial Surveillance Program in 2016 (for Cyprus, Kenya and Peru, data were only available from 2015). Note, the areas in grey are disputed territories (e.g. Western Sahara, Jammu and Kashmir) and no antimicrobial resistance data were available from these regions.

Fig. 3.

Percentage of isolates with resistance to azithromycin reported to World Health Organization Global Gonococcal Antimicrobial Surveillance Program in 2016 (for Cyprus and Kenya, data were only available from 2015). Note, the areas in grey are disputed territories (e.g. Western Sahara, Jammu and Kashmir) and no antimicrobial resistance data were available from these regions.

Fig. 4.

Percentage of isolates with resistance to ciprofloxacin reported to World Health Organization Global Gonococcal Antimicrobial Surveillance Program in 2016 (for Cyprus, Dominican Republic, Kenya and Panama, data were only available from 2015). Note, the areas in grey are disputed territories (e.g. Western Sahara, Jammu and Kashmir) and no antimicrobial resistance data were available from these regions.