Abstract
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern. Phylogenetic analyses resolve uncertainties regarding genetic relatedness of isolates with identical phenotypes and inform whether AMR is due to new mutations and clonal expansion or separate introductions by importation. We sequenced 1,277 isolates with associated epidemiologic and antimicrobial susceptibility data collected during 2013–2016 to investigate N. gonorrhoeae genomic variability in England. Comparing genetic markers and phenotypes for AMR, we identified 2 N. gonorrhoeae lineages with different antimicrobial susceptibility profiles and 3 clusters with elevated MICs for ceftriaxone, varying mutations in the penA allele, and different epidemiologic characteristics. Our results indicate N. gonorrhoeae with reduced antimicrobial susceptibility emerged independently and multiple times in different sexual networks in England, through new mutation or recombination events and by importation. Monitoring and control for AMR in N. gonorrhoeae should cover the entire population affected, rather than focusing on specific risk groups or locations.
Highlights
Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global concern
We focused on N. gonorrhoeae with mutations in the penA allele, which contribute to reduced susceptibility to ceftriaxone
We identified 226 different sequence types (STs) by using N. gonorrhoeae multiantigen sequence typing (NG-MAST) (Appendix)
Summary
Phylogenetic analyses resolve uncertainties regarding genetic relatedness of isolates with identical phenotypes and inform whether AMR is due to new mutations and clonal expansion or separate introductions by importation. To clarify the spread of AMR in N. gonorrhoeae and the population groups most at risk, surveillance programs and research studies often link phenotypic susceptibility data with data on the epidemiologic characteristics of cases [6,7]. These analyses are limited because isolates with identical phenotypes might not be genetically related. Few N. gonorrhoeae WGS studies have been conducted in England, and none include representative geographic coverage over time [10,11,12,13]
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