Neisseria Gonorrhoeae Research Articles (Page 1)

Background/Objectives: Neisseria gonorrhoeae can develop resistance to antimicrobial treatments, posing a challenge to effective management of patients. Alberta, Canada, monitors the antimicrobial susceptibility of gonorrhea isolates to track resistance trends. This study aims to retrospectively analyze susceptibility data and demographic trends from gonorrhea cases in the province over a seven-year period. Methods: Antimicrobial susceptibility testing was performed using gradient strip methodology on gonorrhea isolates from Alberta, evaluating both historical and currently recommended antimicrobials for treatment of gonorrhea. Susceptibility testing results were interpreted using Clinical and Laboratory Standards Institute (CLSI) breakpoints. Provincial antimicrobial susceptibility testing data were analyzed using STATA v.17, incorporating antimicrobial resistance patterns and demographic information from provincial databases. Results: Between 2016 and 2022, 4056 N. gonorrhoeae isolates were cultured from 3617 individuals. All isolates tested were susceptible to ceftriaxone and cefixime, except for a single resistant isolate in 2018. Azithromycin susceptibility ranged from 99% to 88%, with the lowest susceptibility observed in 2018. Males exhibited higher rates of antimicrobial non-susceptibility than females across all drugs tested, except for tetracycline. Conclusions: Ongoing antimicrobial susceptibility surveillance in Alberta is crucial for identifying resistance trends and informing the development of effective treatment strategies for gonorrhea.

To assess the impact of doxycycline post-exposure prophylaxis (DoxyPEP) on Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis (SPL) incidence in a high-risk MSM cohort in a real-world setting. HIV pre-exposure prophylaxis (PrEP) users at high risk of sexually transmitted infections (STIs) seen in our clinic between March 2023 and August 2024 were offered DoxyPEP. The incidence of the first CT, NG and SPL episode was compared between pre-DoxyPEP and post-DoxyPEP periods using Cox proportional hazard models. NG and MDR bacteria cultures were also conducted. Among 876 PrEP users, 197 (22.4%) were eligible and initiated DoxyPEP; 98.4% were MSM. Incidence rates per 100 people per year for the first STI episode in the pre- and post-DoxyPEP periods were: 31.4 and 7.8 (P = 0.0001) for CT, 41.5 and 28.9 (P = 0.1) for NG, and 21.5 and 3.2 (P = 0.0001) for SPL. NG culture was positive in 14 (29.7%) of 47 NG infections detected by PCR in the post-DoxyPEP period. All isolates were sensitive to ceftriaxone, and resistance to tetracyclines was similar to those not on DoxyPEP (42.7% versus 46.3%, P = 0.23). DoxyPEP was discontinued in nine (4.5%) participants. Prevalence of MDR bacteria was similar at baseline and at 48 weeks (10.6% versus 8.2%; P > 0.5). DoxyPEP was well accepted within routine PrEP care, significantly reducing STI incidence with good tolerance. Our data show its efficacy and safety in real-world settings. The emergence of MDR bacteria or resistant NG was not observed. However, its impact on bacterial resistance and the microbiota requires further evaluation.

Introduction: Gonococcal infective endocarditis (IE) is a rare but aggressive complication of disseminated gonococcal infection (DGI), occurring in only 1–2% of DGI cases. While DGI typically presents as a triad of arthralgia, tenosynovitis, and skin lesions, cardiac involvement is very uncommon and often easily missed. We report a unique case of gonococcal IE in a healthy young male without any genitourinary symptoms. Case Presentation: A 24-year-old male with no past medical history presented to the ED with dull, non-radiating substernal chest pain, worsened by rest and relieved by leaning forward. Vital signs revealed a temperature of 100.3°F and a heart rate of 120 bpm. Physical examination noted a grade 3/6 diastolic murmur, loudest at the left upper sternal border. He denied IV drug use but reported remote oral and vaginal sexual encounters. Transthoracic echocardiography (TTE) showed an ejection fraction of 58% with a mobile echodensity on the aortic valve, severe aortic regurgitation, and holo-diastolic flow reversal in the descending aorta. Transesophageal echocardiography (TEE) confirmed a 1.4 × 0.8 cm mobile echogenic mass consistent with vegetation, and an abscess in the right coronary part of the aortic annulus. The patient was started on broad-spectrum antibiotics, including vancomycin and ampicillin-sulbactam. Intraoperatively, vegetations were observed on the left and right coronary leaflets, with a small perivalvular abscess at the left-right coronary commissure. The aortic valve was reconstructed with a mechanical valve. Blood cultures and throat swabs were positive for Neisseria gonorrhoeae. Surgical pathology revealed moderate to severe acute and chronic inflammation, consistent with acute/subacute infective endocarditis, although tissue Gram stain was negative for definitive bacteria. Conclusion: Gonococcal IE is an exceedingly rare yet life-threatening entity, with reported mortality rates of 19–20%, likely due to rapid valvular destruction and large vegetations. Interestingly, valve cultures are often sterile, so diagnosis typically relies on blood or mucosal cultures. Given the potentially devastating consequences of delayed recognition, this case emphasizes the importance of considering gonococcal etiology in endocarditis, particularly in young, sexually active individuals without classic symptoms. Reporting such cases helps towards forming evidence-based treatment guidelines and strengthening awareness of this rare presentation.

Implementation of community pharmacy-based testing and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia (Swab-Rx study).

2-Hydroxychalcone is a gonococcal-specific antimicrobial with activity against elongation factor Tu and butanediol dehydrogenase.

Current global trends in meningococcal disease control, risk groups and vaccination: Consensus of the Global Meningococcal Initiative.

Pathological vaginal discharge is caused by infections from pathogens such as Trichomonas vaginalis, Candida species, Chlamydia trachomatis, and Neisseria gonorrhoeae. Pathological vaginal discharge can cause discomfort, and if left untreated for a long time, it may lead to pelvic inflammatory disease, infertility, and cervical cancer. The Health Belief Model (HBM) is the most commonly used model to guide individuals toward engaging in preventive health behaviors. The application of HBM in preventing pathological vaginal discharge is important because it helps increase awareness and promote preventive behaviors. The use of natural ingredients to address pathological vaginal discharge is becoming more familiar among the community compared to synthetic products due to their safety and affordability.Research Objectives: To analyze the effectiveness of basil leaf decoction, evaluate the influence of HBM on preventing pathological vaginal discharge, and determine the effectiveness of the combination of basil leaf decoction and HBM.Methods: This study employed a quasi-experimental design with a pre-test and post-test control group conducted in Lubuk Pakam village. Respondents were divided into three groups with a total sample size of 150 individuals.Results: Pre-test results showed that initial scores were almost the same across all groups, indicating no significant differences before the intervention. After six weeks, the basil decoction group showed a 24.6% improvement in preventive behavior, the HBM group showed a 33.4% increase, and the combination group showed a 45.7% increase. These findings indicate that the combination of basil leaf decoction and HBM education is more effective than single interventions.The HBM model proved effective in enhancing awareness and preventive behavior, especially when combined with biological intervention such as basil leaf decoction. This combination produced a synergistic effect that encouraged higher compliance and stronger behavioral change compared to single interventions.The combination of basil leaf decoction and education based on the Health Belief Model (HBM) was found to be the most effective in improving preventive behaviors against pathological vaginal discharge in women of reproductive age compared to single interventions. This intervention significantly increased knowledge, perception, and motivation to carry out preventive actions. Therefore, this combined biological and educational approach is recommended for widespread implementation in women's reproductive health programs.

Despite decades of research, an effective vaccine against Neisseria gonorrhoeae remains elusive due to the pathogen's antigenic variability and immune evasion capabilities. Retrospective studies of OMV-based meningococcal vaccines have shown a partial effectiveness against gonorrhea, reigniting hopes for a feasible vaccine. Our study focused on the role of gonococcal lipooligosaccharides (LOS), the most abundant antigens on the surface, in stimulating functional immune responses. By employing detoxified OMV from Neisseria gonorrhoeae isogenic strains expressing different LOS glycoforms, we observed that antibodies targeting LOS with long α-chain oligosaccharides correlated with bactericidal activity against a wide range of gonococcal isolates, whereas antibodies that also recognized the β-chain and consequently the 2C7 epitope could achieve a broader bacterial adhesion-inhibiting effect. The results obtained underscore the potential of targeting defined LOS structures to elicit cross-strain protective immunity. Insights from our findings may guide the design of vaccine strategies to combat the threat posed by antimicrobial-resistant gonorrhea.

Sexually transmitted infections, e.g., Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG), present with similar signs/symptoms and are often treated empirically due to delays in receiving diagnostic test results. This study evaluated the clinical performance of the Cobas Liat CT/NG/MG nucleic acid amplification test (NAAT) in detecting these pathogens in a point-of-care (POC) setting. This non-interventional, multicenter study recruited symptomatic/asymptomatic participants from 13 geographically diverse POC sites across the USA. Prospective clinician- and self-collected specimens (urine/vaginal swabs) were used to determine the sensitivity and specificity of the Cobas Liat CT/NG/MG test relative to the composite reference standard (CRS), determined using a combination of results from three FDA-approved NAATs and one laboratory-developed test. Among 4,800 evaluable participants, 40.4% (n = 1,941) were symptomatic, and 51.9% (n = 2,489) were female at birth. The Cobas Liat CT/NG/MG test demonstrated good clinical performance across all specimen types regardless of symptom status, with specificity >97% for each analyte, and sensitivity ≥92%, except female urine (≥CT 87%, NG ≥ 83%, MG ≥ 77%). The test was considered easy to use, and no statistically significant difference in performance results was observed between trained/untrained users. The Cobas Liat CT/NG/MG test demonstrated good clinical performance, with high sensitivity and specificity for CT/NG/MG detection, regardless of symptom status. The assay provides a short turn-around time (approximately 20 min) with centralized testing laboratory accuracy at the POC for self- and clinician-collected samples. POC testing can facilitate rapid pathogen identification and accurate treatment, thereby mitigating the need for empiric treatment.IMPORTANCENucleic acid amplification tests are the preferred method for diagnosing CT and NG infections and are the only reliable tests for MG; however, delays in receiving results can lead to empiric treatment, potentially causing misdiagnosis and overtreatment of STIs. Point-of-care testing could mitigate these issues by enabling rapid pathogen identification and treatment, but no rapid POC tests are currently available for the detection of CT, NG, and MG despite the similarity of symptoms, and these three pathogens being responsible for the majority of symptomatic STIs in some settings. Our findings suggest that the Cobas Liat CT/NG/MG assay may help to reduce reliance on empiric treatment of symptoms and minimize resulting return visits for unresolved infections. Use of the Cobas Liat CT/NG/MG assay may also result in improved patient outcomes, help realize population benefits by reducing the duration of infection and potentially transmission, and reduce healthcare costs.

ABSTRACT There are no prophylactic vaccines for preventing the disease gonorrhea, caused by sexually transmitted infection with the Gram-negative pathogen Neisseria gonorrhoeae. In this study, we examined the antigenicity in mice of a recombinant rMafA 2/3 outer membrane protein (OMP). Mice were immunized with rMafA 2/3 with different adjuvants and delivery vehicles, which induced high levels of antibody that recognized the MafA 2/3 protein in i) antigen and OM-ELISA, ii) OM-western blots and iii) on whole bacteria examined with flow cytometry. Antisera to rMafA 2/3 in liposomes with monophosphoryl lipid A (MPLA) and with Zwittergent 3–14 ± MPLA, were bactericidal in vitro for homologous P9-17 (Allele 193) gonococcal strain (median 50% bactericidal titers of 256). Analysis of MafA 2/3 alleles among gonococcal isolates in the PubMLST database showed that ~50% and 26% of gonococci expressed Allele 90 and Allele 88-encoded protein respectively, and these proteins were identical bar one amino acid substitution. Murine antisera to Allele 193 rMafA 2/3 expressing strain P9-17 (~98% homology with Alleles 88/90 MafA 2/3 protein) showed bactericidal activity against heterologous strain FA1090 (Allele 88, 50% median titers from 4 to 64), but not to heterologous strain AR205 (Allele 90). By contrast, a rabbit anti-rMafA 2/3 serum was bactericidal for P9-17, FA1090, and AR205 (50% titers of 2048–4096), and inhibited significantly (p <0.05) the association of gonococci to human Chang conjunctival epithelial cells in vitro. These findings suggest that MafA 2/3 could be a promising OMP for further study as a component of future subunit gonococcal vaccines.

Background: Cervicitis is frequently caused by sexually transmitted infections (STIs), including Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis. The emergence of antimicrobial resistance (AMR) in N. gonorrhoeae presents significant treatment challenges, making it essential to monitor the molecular epidemiology and resistance profiles of this pathogen. Objective: This study was aimed to investigate the molecular epidemiology, antimicrobial resistance patterns, and the prevalence of Neisseria gonorrhoeae in cervicitis cases, with a focus on detecting resistance-associated genes and the co-occurrence of other STIs, including HPV. Methodology: This cross-sectional study was conducted in the Department of Microbiology, Dhaka Medical College, Bangladesh, with sample collection from the gynaecology outpatient department between January and December 2017, and included female patients with clinically suspected cervicitis. A total of 248 cervical swab samples were collected from women with cervicitis. The samples were analyzed using Gram staining, bacterial culture, PCR, and antimicrobial susceptibility testing. PCR was also employed to detect resistance-related genes and HPV strains in cervical biopsy specimens. Results: Of the 248 cervical swab samples, Neisseria gonorrhoeae was detected in 10.48% of cases. Antimicrobial resistance testing revealed high levels of resistance to Ciprofloxacin (92.86%) and Tetracycline (85.71%) among the N. gonorrhoeae isolates, with 57.14% also resistant to Doxycycline. Notably, all isolates remained susceptible to Ceftriaxone and Cefixime, which continue to be highly effective for treatment. Penicillinase-producing N. gonorrhoeae strains were identified in 71.42% of cases, indicating ongoing selective pressure for resistance. PCR analysis also revealed the presence of resistance-associated genes, including penA, mtrR, and porB. In addition, HPV DNA was detected in 16.66% of cervical biopsy samples, with HPV-16 identified in 13.33% and HPV-18 in 3.33%. Co-infection with other STIs was observed in 25.40% of the N. gonorrhoeae-positive cases. Conclusion: Neisseria gonorrhoeae remains a significant cause of cervicitis with high resistance to common antibiotics. Regular surveillance of antimicrobial resistance is crucial for treatment management. The study also emphasizes the importance of HPV vaccination to reduce cervical cancer risk, particularly for HPV-16 and HPV-18. Bangladesh Journal of Infectious Diseases, June 2025;12(1):42-51

National guidelines regarding sexually transmitted infections recommend Human Immunodeficiency Virus (HIV) screening for all patients evaluated for sexually transmitted infections (STI). At our institution, compliance with HIV screening in the Emergency Department (ED) for these patients was noted to be suboptimal. Human Immunodeficiency Virus screening was limited because of HIV screening and confirmatory antigen/antibody assay being transported to another location, which caused result delays and led ED providers to defer testing to Primary Care Managers (PCMs). Rapid HIV testing was implemented in our ED as a quality improvement initiative in an effort to improve compliance with guideline recommended HIV screening for these encounters. Rapid HIV testing for patients undergoing Neisseria gonorrhea and Chlamydia trachomatis (GC/CT) testing was implemented in the ED beginning in December 2021. Three months of pre-intervention data (August-October 2021) and 3 months of post-intervention data (December 2021-February 2022) were collected. Before the post-intervention period, ED providers received education regarding the initiative and were encouraged to include rapid HIV testing for patients presenting with STI complaints. Chart review was performed for all patients tested for GC/CT during the study period; date collected included demographic, clinical, and laboratory data to assess HIV screening practices. A total of 571 patients underwent GC/CT testing across the study period (303 pre-intervention and 268 post-intervention). Rates of bacterial STIs were similar between the 2 periods (13.5% vs. 10.8%, pre- vs. post-intervention, respectively, P = .324). Additionally, empiric treatment for GC/CT was similar in the pre-intervention period (38.3% vs. 34.3%, P = .327) compared to the post-intervention period. Screening for HIV significantly increased following the introduction of rapid HIV testing (4.3% vs. 19.8%, P = .001). Human Immunodeficiency Virus screening rates were also assessed at primary care follow-up for those not screened in the ED. Human Immunodeficiency Virus screening at primary care follow-up remained low in the pre- and post-intervention periods (6.2% vs. 8.4%, P = .35). Sexually transmitted infections are considered biologic markers of HIV risk, including acquisition and forward transmission. Implementation of rapid HIV testing in the ED resulted in a nearly 5-fold increase in HIV screening in patients evaluated for GC/CT. Despite this increase, the overall rate of HIV screening in the ED remained low. HIV screening during PCM follow-up remained expectedly low across the study period, given that our intervention did not target PCM follow-up. This study demonstrates the success of a relatively easy-to-implement intervention for increasing HIV screening for STI encounters in our ED. Further studies are needed to explore barriers to HIV screening at primary care follow-up and methods to improve compliance with guideline recommended screening.

Introduction. Antimicrobial susceptibility testing (AST) of Neisseria gonorrhoeae isolates is recommended in the UK to ensure antimicrobial stewardship and detection of multi-drug and extensively resistant cases. In diagnostic and reference laboratories, this testing is primarily carried out via a gradient strip. However, agar dilution methodology may also be used for high-throughput testing.Gap statement.N. gonorrhoeae is not a validated species on all ETEST (bioMérieux, France) gradient strip formulations available, and, therefore, additional comparative validation data are required to support use in clinical laboratory settings.Aim. To determine the reproducibility of ETEST for AST of N. gonorrhoeae, and to demonstrate the comparability of susceptibility results obtained using agar dilution and gradient strip methods.Methodology. Modal ETEST MICs for six well-characterized World Health Organization N. gonorrhoeae control strains, against eight antimicrobials, were calculated. ETEST modal MICs were compared to published and local, historical agar dilution MICs. MICs were interpreted using European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. Concordance of ETEST modal MICs, within essential and categorical agreement, for each strain was calculated.Results. Overall, 95.80% of modal ETEST MICs were within essential agreement with published MICs. Where variance from exact concordance was noted, a systematic shift was observed to lower MICs in this study. On three occasions, variance from the published MIC resulted in a categorical classification change. On two occasions, the modal ETEST MIC in this study was two doubling dilutions lower than the published MIC. Neither resulted in a categorical classification change. When modal ETEST and agar dilution MICs were compared, overall essential agreement was 83.30%. However, this increased to 94.4% when concordance was analysed for clinically important antimicrobials: azithromycin, cefixime and ceftriaxone. Again, a systematic shift to lower MICs for ETEST was observed in this study. Categorical agreement was 83.3% for all antimicrobials and 100% for clinically important antimicrobials.Conclusion. Excellent concordance was demonstrated for MICs generated using ETEST with published MICs. Good concordance was observed for MICs generated using two different susceptibility testing methodologies. Where variance was noted, MICs generally read lower on ETEST in this study. ETEST remains fit for purpose for the AST of N. gonorrhoeae, a clinically important pathogen.

To characterize computed tomography (CT) findings in women with pelvic inflammatory disease (PID) due to PCR-confirmed Chlamydia trachomatis or Neisseria gonorrhoeae, and to identify imaging patterns that may assist diagnosis in the emergency setting. We conducted a retrospective study of 44 female patients who underwent abdominal or pelvic CT in the gynecology emergency department and tested positive for C.trachomatis, N. gonorrhoeae, or both. CT images were re-evaluated by two radiologists for signs consistent with PID. Imaging findings were compared across three analyses: (1) cases correctly vs. incorrectly diagnosed in the original radiology report, (2) concordant vs. discordant interpretations between original and retrospective reads, and (3) differences between infections caused by C.trachomatis and N.gonorrhoeae. CT features consistent with PID were present in 77.3% of cases. The most frequent findings were fat stranding (86.4%), free pelvic fluid (79.5%), and peritoneal thickening (72.7%). Tubo-ovarian abscesses (TOAs) occurred in 36.4% and were always correctly identified. Subtle peritoneal thickening was more frequent in discordant interpretations (100% vs 63%, p = 0.01). Fallopian-tube thickening was more common in C. trachomatis than N. gonorrhoeae infection (49% vs 11%, p = 0.013). CT often reveals characteristic features of PID even when the condition is not clinically suspected. Subtle radiologic findings-particularly peritoneal thickening or enhancement and pelvic fat stranding- are often overlooked during emergency evaluation. Increased awareness of these signs may facilitate earlier recognition and management.

The Neisseria gonorrhoeae Type IV pilus is a dynamic fiber involved in host cell attachment, DNA transformation, twitching motility, and evading the innate immune system. We previously reported that pilus expression affects iron homeostasis and sensitivity to killing by oxidative (iron-dependent antibiotic streptonigrin and hydrogen peroxide and non-oxidative (antimicrobial peptide LL-37) agents. Here, we use in vitro evolution to identify genes involved in N. gonorrhoeae susceptibility to streptonigrin. We identified a mutation in the NGO0059 locus that encodes HpaC that results in a glycine to cysteine change in position 93. Although HpaC homologs are known as part of a two-component FAD-dependent monooxygenase system consisting of an hpaC reductase and an hpaB monooxygenase, Neisseria lack the monooxygenase. While HpaC increases streptonigrin sensitivity, HpaC also promotes hydrogen peroxide and LL-37 resistance. We tested whether the HpaC effect in streptonigrin, hydrogen peroxide and LL-37 sensitivity involved the Type IV pilus. We determined that HpaC affects streptonigrin independently of the pilus while hydrogen peroxide- and LL-37-mediated killing involves both HpaC and the pilus. We demonstrate that the Gly93Cys change conferred enhanced affinity for FAD and resulted in a loss-of-function phenotype in streptonigrin susceptibility. These data suggest that HpaC’s role in FAD oxidation and reduction impacts pilus-dependent and -independent resistance against neutrophil-mediated killing.

The Neisseria gonorrhoeae Type IV pilus is a dynamic fiber involved in host cell attachment, DNA transformation, twitching motility, and evading the innate immune system. We previously reported that pilus expression affects iron homeostasis and sensitivity to killing by oxidative (iron-dependent antibiotic streptonigrin and hydrogen peroxide and non-oxidative (antimicrobial peptide LL-37) agents. Here, we use in vitro evolution to identify genes involved in N. gonorrhoeae susceptibility to streptonigrin. We identified a mutation in the NGO0059 locus that encodes HpaC that results in a glycine to cysteine change in position 93. Although HpaC homologs are known as part of a two-component FAD-dependent monooxygenase system consisting of an hpaC reductase and an hpaB monooxygenase, Neisseria lack the monooxygenase. While HpaC increases streptonigrin sensitivity, HpaC also promotes hydrogen peroxide and LL-37 resistance. We tested whether the HpaC effect in streptonigrin, hydrogen peroxide and LL-37 sensitivity involved the Type IV pilus. We determined that HpaC affects streptonigrin independently of the pilus while hydrogen peroxide- and LL-37-mediated killing involves both HpaC and the pilus. We demonstrate that the Gly93Cys change conferred enhanced affinity for FAD and resulted in a loss-of-function phenotype in streptonigrin susceptibility. These data suggest that HpaC's role in FAD oxidation and reduction impacts pilus-dependent and -independent resistance against neutrophil-mediated killing.

Computer-aided identification of Neisseria gonorrhoeae’s Bacteriophage-Q-beta inhibitors from selected anti-gonorrheal plants

To evaluate adherence patterns, effectiveness, and sexually transmitted infection (STI) incidence among pre-exposure prophylaxis (PrEP) users in Germany and identify strategies to optimize HIV and STI prevention through individualized care and alternative PrEP modalities. A single-site, pseudonymized prospective cohort study was conducted in Hamburg, Germany from December 2019 to September 2024. Clinical and laboratory data were linked with structured behavioral surveys from PrEP users at the University Medical Center Hamburg-Eppendorf. Of 980 consented individuals, 589 initiated PrEP (median age 32years, 97.1% male, and 81.8% were born in Germany). The mean follow-up was 102.3weeks (IQR: 38.6-151.4), totaling 1189.5 person-years. Daily users averaged 315days of PrEP coverage per year (IQR: 293.0-361.9days), whereas on-demand users averaged 219days (IQR: 138.4-311.6days), highlighting substantial variability in usage patterns. The overall dropout rate was 46.9%. No cases of HIV occurred during active PrEP use. STI incidence remained high 52.4 /100 PY (95% CI: 47.8-57.4, n = 421) for daily PrEP users, 38.9/100 PY (95% CI: 30.1-49.5, n = 79) for event-driven users, predominantly due to Chlamydia trachomatis (21.1/100 PY) and Neisseria gonorrhoeae (18.8/100 PY). Interest in long-acting PrEP was high (70%), especially among illicit substance users (OR 5.54). Renal function remained stable during follow-up. PrEP demonstrated high effectiveness despite heterogeneous risk burden and generally stable renal function. This supports flexible, person-centered models with simplified, risk-stratified monitoring and long-acting options. To extend impact beyond MSM, services should add multilingual access and women- and migrant-inclusive outreach.

ABSTRACT Resistance to the last treatment option for gonorrhoea, ceftriaxone is a major public health concern globally, which poses a serious threat to the currently recommended ceftriaxone monotherapy. We elucidate the emergence, evolution and temporal spread of ceftriaxone-resistant gonococcal strains in China, using whole-genome sequencing of 357 ceftriaxone-resistant isolates from eight provinces during 2002–2022. We describe distinct differences between ceftriaxone-resistant gonococcal strains in China and global isolates. The resistance levels for the 357 isolates for cefixime, azithromycin, ciprofloxacin, benzylpenicillin, tetracycline, and spectinomycin were 92.4%, 17.0%, 100%, 84.9%, 92.7%, and 0.8%, respectively. Before 2019, ceftriaxone-resistant isolates in China mainly harboured non-mosaic penA alleles like penA-13, penA-12, penA-18 or mosaic penA-10. From 2019, ceftriaxone-resistant isolates with mosaic penA-60.001 increased rapidly, becoming the dominant penA allele. Meanwhile, penA-60.001 was horizontally transferred from MLST ST1903 strains to strains of other MLST STs that were prevalent in China. Notably, the MLST ST7365 isolates with penA-60.001 allele had higher ceftriaxone MICs than isolates of the typical ST1903 FC428 clone. This may be attributed to a main clade of MLST ST7365 strains in China exhibiting elevated ceftriaxone MICs, and the temporal phylogeny showed this clade emerged around 1994. In summary, we reveal the unique genomic and evolutionary patterns of ceftriaxone-resistant gonococcal strains in China, and the 357 not previously reported isolates substantially increase the number of global ceftriaxone-resistant isolates. Our results suggest potential evolutionary pathways and directions of ceftriaxone-resistant strains, and provide valuable data for examining genomic epidemiology, antimicrobial resistance determinants and formulating strategies for surveillance and interventions.

The fourth nationwide surveillance of antimicrobial susceptibility against Neisseria gonorrhoeae from male urethritis in Japan, 2021.