Detection of the United States Neisseria meningitidis urethritis clade in the United Kingdom, August and December 2019 – emergence of multiple antibiotic resistance calls for vigilance

Abstract

Since 2015 in the United States (US), the US Neisseria meningitidis urethritis clade (US_NmUC) has caused a large multistate outbreak of urethritis among heterosexual males. Its ‘parent’ strain caused numerous outbreaks of invasive meningococcal disease among men who have sex with men in Europe and North America. We highlight the arrival and dissemination of US_NmUC in the United Kingdom and the emergence of multiple antibiotic resistance. Surveillance systems should be developed that include anogenital meningococci.

Genomic analysis of the meningococcal ST-4821 complex–Western clade, potential sexual transmission and predicted antibiotic susceptibility and vaccine coverage

“…Furthermore, the second group also differed from one-another by serogroup. This, along with the finding of the recent msm carriage study in New York (USA) [ 14 ], may be indicative of a propensity for this cluster to infect the anogenital site as has previously been observed with ST-11 complex lineage 11.2 strains [ 15 , 16 , 18 ]. One factor in the emergence of anogenital-associated cc11 strains was the acquisition of an active nitrite reductase ( aniA ) gene [ 15 , 18 ].…”

“…Members of another strain, ST-11 complex lineage 11.2, have caused multiple outbreaks of IMD in MSM in Europe and the USA and a large multistate outbreak of urethritis among predominantly heterosexual men in the USA [ 15 ]. The latter strain (US_NmUC) has recently been detected in proctitis in MSM in the United Kingdom [ 16 ]. The strains responsible have shown several adaptations to the anogenital niche including the acquisition of active/efficient denitrification genes ( aniA and norB ) to enable growth in an anaerobic environment [ 17 , 18 ].…”

A Narrative Review of the W, X, Y, E, and NG of Meningococcal Disease: Emerging Capsular Groups, Pathotypes, and Global Control

“…This is certainly an underestimate due to possible misidentification by N. gonorrhoeae diagnostic assay [ 99 ]. In 2019, two US_NmUC isolates were reported in MSM in the United Kingdom [ 100 ]. One of the UK isolates had acquired a frameshifted gonococcal maltose phosphorylase gene, resulting in a carbohydrate utilization profile more typically associated with gonococci [ 100 ].…”

“…In 2019, two US_NmUC isolates were reported in MSM in the United Kingdom [ 100 ]. One of the UK isolates had acquired a frameshifted gonococcal maltose phosphorylase gene, resulting in a carbohydrate utilization profile more typically associated with gonococci [ 100 ]. Ecological separation within the human host is proposed as an explanation for the lower frequency of interspecies recombination noted between naturally competent N. meningitidis and N. gonorrhoeae [ 101 ].…”

“…Further, one 2015 isolate had a gonococcal-like mtrR allele that is associated with elevated azithromycin MICs [ 6 ] and 7 out of 10 isolates recovered during 2018–2019 in St. Louis, MO, are non-susceptible to azithromycin [ 99 ]. In addition, intermediate penicillin resistance was seen in the clade, and one UK isolate, having acquired part of a gonococcal DNA gyrase ( gyrA ) gene, was resistant to ciprofloxacin [ 100 ]. These multiple recombination events demonstrated widespread acquisition of gonococcal DNA by US_NmUC and suggested that co-colonization of these two species had facilitated genetic exchanges and raised the prospect of further acquisition of gonococcal antibiotic resistance determinants [ 100 ].…”