Abstract
Ceftriaxone remains a first-line treatment for patients infected by Neisseria gonorrhoeae in most settings. We investigated the possible spread of a ceftriaxone-resistant FC428 N. gonorrhoeae clone in Japan after recent isolation of similar strains in Denmark (GK124) and Canada (47707). We report 2 instances of the FC428 clone in Australia in heterosexual men traveling from Asia. Our bioinformatic analyses included core single-nucleotide variation phylogeny and in silico molecular typing; phylogenetic analysis showed close genetic relatedness among all 5 isolates. Results showed multilocus sequence type 1903; N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) 233; and harboring of mosaic penA allele encoding alterations A311V and T483S (penA-60.001), associated with ceftriaxone resistance. Our results provide further evidence of international transmission of ceftriaxone-resistant N. gonorrhoeae. We recommend increasing awareness of international spread of this drug-resistant strain, strengthening surveillance to include identifying treatment failures and contacts, and strengthening international sharing of data.
Highlights
We investigated the possible spread of a ceftriaxone-resistant FC428 N. gonorrhoeae clone in Japan after recent isolation of similar strains in Denmark (GK124) and Canada (47707)
There are serious gaps in N. gonorrhoeae antimicrobial resistance surveillance worldwide [21], and we estimate that samples from as few as 0.1% of the estimated 80 million cases of N. gonorrhoeae reported globally each year [22] are tested for antimicrobial resistance
The ceftriaxone MICs of the FC428 clonal strain remain lower than the H041 strain from Japan (MIC 2 mg/L) [2], and further, the FC428 strain does not exhibit resistance to azithromycin (Table 1)
Summary
RESEARCH (including ceftriaxone-resistant MIC 1 mg/L and PPNG; Table 1 [10]) was isolated from a sample collected from a 23-year-old woman This patient had no history of travel, but her male partner, who had been treated empirically and had no culture results available, reported sexual contact during travel in China and Thailand during the fall of 2016. The strain from Denmark (GK124) was isolated in January 2017, had a similar susceptibility profile to FC428, and was obtained from a heterosexual man in his twenties who had reported unprotected sexual contact with women from Denmark, China, and Australia [9]. We report additional FC-428–like cases among persons in Australia, providing further evidence of the sustained international transmission of a ceftriaxoneresistant N. gonorrhoeae strain
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