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Review
. 2022 Oct;27(40):2200057.
doi: 10.2807/1560-7917.ES.2022.27.40.2200057.

Antimicrobial-resistant gonorrhoea: the national public health response, England, 2013 to 2020

Rachel Merrick  1 , Michelle Cole  1 , Rachel Pitt  1 , Qudsia Enayat  1 , Zdravko Ivanov  1 , Michaela Day  1 , Suzy Sun  1 , Katy Sinka  1 , Neil Woodford  1 , Hamish Mohammed  1 , Helen Fifer  1
Affiliations
Review

Antimicrobial-resistant gonorrhoea: the national public health response, England, 2013 to 2020

Rachel Merrick et al. Euro Surveill. 2022 Oct.

Abstract

Neisseria gonorrhoeae 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 N. gonorrhoeae 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 N. gonorrhoeae. Between 2013 and 2019, diagnoses of gonorrhoea in England rose by 128% to 70,922, the largest annual number ever reported. Over this period, N. gonorrhoeae 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 N. gonorrhoeae strains with ceftriaxone resistance and to rapidly contain transmission of these strains within England.

Keywords: antimicrobial resistance; gonorrhoea; surveillance; treatment.

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Conflict of interest statement

Conflict of interest: UKHSA’s Antimicrobial Resistance and Healthcare Associated Infections Reference Unit has received financial support for conference attendance, lectures, research projects, or contracted evaluations from numerous sources, including Accelerate, Achaogen, Allecra, Amplex, AstraZeneca, Basilea, Becton Dickinson Diagnostics, bioMerieux, Bio-Rad Laboratories, the BSAC, Cepheid, Check-Points, Cubist Pharmaceuticals, Department of Health, European Centre for Disease Prevention and Control, Enigma Diagnostics, Food Standards Agency, GlaxoSmithKline, Henry Stewart Talks, IHMA, Kalidex, Melinta, Merck Sharpe and Dohme, Meiji, Mobidiag, Momentum Biosciences, Nordic, Norgine, Rempex, Roche, Rokitan, Smith and Nephew, Trius, VenatoRx, and Wockhardt. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Percentage of Neisseria gonorrhoeae isolates in the GRASP sentinel surveillance system that were resistant to selected antimicrobials, England and Wales, 2000–2020
Figure 2
Figure 2
Timeline of incidents with antimicrobial-resistant Neisseria gonorrhoeae and related events, England, 2000–2020
See this image and copyright information in PMC

References

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