Abstract
BackgroundEmerging antimicrobial resistance (AMR) challenges gonorrhoea treatment and requires surveillance.AimThis observational study describes the genetic diversity of Neisseria gonorrhoeae isolates in Germany from 2014 to 2017 and identifies N. gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics.Methods1,220 gonococcal isolates underwent AMR testing and NG-MAST. Associations between genogroups and AMR or sex/age of patients were statistically assessed.ResultsPatients’ median age was 32 years (interquartile range: 25–44); 1,078 isolates (88.4%) originated from men. In total, 432 NG-MAST sequence types including 156 novel ones were identified, resulting in 17 major genogroups covering 59.1% (721/1,220) of all isolates. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal–Wallis chi-squared: 549.3442, df: 16, p < 0.001). Their prevalences appeared to decline during the study period from 14.2% (15/106) to 6.2% (30/481) and from 6.6% (7/106) to 3.1% (15/481) respectively. Meanwhile, several cefixime susceptible genogroups’ prevalence seemed to increase. Proportions of isolates from men differed among genogroups (Fisher’s exact test, p < 0.001), being e.g. lower for G25 (G51) and G387, and higher for G5441 and G2992. Some genogroups differed relative to each other in affected patients’ median age (Kruskal–Wallis chi-squared: 47.5358, df: 16, p < 0.001), with e.g. G25 (G51) and G387 more frequent among ≤ 30 year olds and G359 and G17420 among ≥ 40 year olds.ConclusionAMR monitoring with molecular typing is important. Dual therapy (ceftriaxone plus azithromycin) recommended in 2014 in Germany, or only the ceftriaxone dose of this therapy, might have contributed to cefixime-resistant genogroups decreasing.
Highlights
Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Neisseria gonorrhoeae
Genogroups with an apparent increase in prevalence from 2014 to 2017 included G11461 (from 0.0% (0/106) to 5.6% (27/481)), G17420 (from 0.0% (0/106) to 5.0% (24/481)) and G5441 (from 0.9% (1/106) to 4.8% (23/481)), all of which had low minimum inhibitory concentrations (MICs) values for cefixime, ceftriaxone and azithromycin (Figure 2, 3). This is the first study to genetically describe the population of N. gonorrhoeae strains detected in Germany over a 4-year period of time, linking STs with antimicrobial resistance (AMR) profiles and epidemiological data on age and sex
Gonococcal Resistance Network (GORENET) monitors antimicrobial susceptibility of N. gonorrhoeae in Germany and reported high rates of resistance against azithromycin, benzylpenicillin and ciprofloxacin in vitro between 2014 and 2015, while more than 98% of all strains remained susceptible to ceftriaxone and cefixime [9]
Summary
Gonorrhoea is a sexually transmitted infection (STI) caused by the Gram-negative bacterium Neisseria gonorrhoeae. Estimations of numbers of persons with gonorrhoea worldwide by the World Health Organization (WHO) resulted in 86.9 million cases among adults aged 15 to 49 years in 2016 [1], making N. gonorrhoeae the third most common non-viral STI. Aim: This observational study describes the genetic diversity of Neisseria gonorrhoeae isolates in Germany from 2014 to 2017 and identifies N. gonorrhoeae multi-antigen sequence typing (NG-MAST) genogroups associated with AMR or some patient demographics. Genogroups G1407 and G10557 (G7072) were significantly associated with decreased susceptibility to cefixime (Kruskal–Wallis chi-squared: 549.3442, df: 16, p < 0.001). Their prevalences appeared to decline during the study period from 14.2% (15/106) to 6.2% (30/481) and from 6.6% (7/106) to 3.1% (15/481) respectively. Some genogroups differed relative to each other in affected patients’
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
