Epidemiological Trends of Antibiotic Resistant Gonorrhoea in the United Kingdom

Abstract

Gonorrhoea is one of the most common sexually-transmitted bacterial infections, globally and in the United Kingdom. The levels of antibiotic resistance in gonorrhoea reported in recent years represent a critical public health issue. From penicillins to cefixime, the gonococcus has become resistant to all antibiotics that have been previously used against it, in each case only a matter of years after introduction as a first-line therapy. After each instance of resistance emergence, the treatment recommendations have required revision, to the point that only a few antibiotics can reliably be prescribed to treat infected individuals. Most countries, including the UK, now recommend that gonorrhoea be treated with a dual therapy combining ceftriaxone and azithromycin. While this treatment is still currently effective for the vast majority of cases, there are concerning signs that this will not always remain the case, and there is no readily apparent alternative. Here, we review the use of antibiotics and epidemiological trends of antibiotic resistance in gonorrhoea from surveillance data over the past 15 years in the UK and describe how surveillance could be improved.

Emergence of Neisseria gonorrhoeae Strains Harboring a Novel Combination of Azithromycin-Attenuating Mutations

“…Whole-genome sequencing (WGS) analysis confirmed the results of 23S rRNA (A2059G) mutation and a mosaic-mtr locus obtained by PCR and Sanger sequencing, and it revealed that the mosaicism seen in the mtr locus extended through a large part azithromycin as part of the current treatment regimen (3,6). In recent years, many countries have observed an increase in the prevalence of reduced susceptibility to azithromycin in N. gonorrhoeae.…”

“…A ntimicrobial agents play a critical role in the fight against gonorrhea, a sexually transmitted disease caused by Neisseria gonorrhoeae. The use of antibiotics for gonorrhea management began in the mid-1930s (1)(2)(3). This date also marked the dawn of a perpetual battle against antibiotic-resistant N. gonorrhoeae (AR-Ng).…”

“…Over the last 80ϩ years, N. gonorrhoeae has progressively developed resistance to all first-line antibiotics following their introduction (1). The therapeutic longevity of antibiotics is inversely dependent to the malleability of the genetics of the pathogen (3). Neisseria gonorrhoeae demonstrates a high degree of genetic plasticity and uses this plasticity as a mechanism to develop antimicrobial resistance.…”

Targeted surveillance strategies for efficient detection of novel antibiotic resistance variants

“…, through epistatic interactions with other genetic variants) within and/or across different antibiotics when screening for a novel resistance variant. For example, as ciprofloxacin was the recommended first-line therapy for uncomplicated gonorrhea through 2005 in the United Kingdom 46 , 2007 in the United States 47 , and more recent years in other countries 48–50 , we investigated whether resistance to ESCs is significantly more likely to occur in the background of genotypic ciprofloxacin resistance ( i.e. , in strains with the GyrA S91F mutation).…”

Vaccination against antibiotic resistant gonorrhoea for men who have sex with men in England: a modelling study

“…1 In England there is a growing epidemic of gonorrhoea, while treatment is becoming harder, particularly among men who have sex with men (MSM). 2 In 2019, rising azithromycin resistance in the UK has led to the drug's removal from the previously recommended dual therapy. 3 The remaining component, ceftriaxone, is now both the first and last line of treatment, with worrying signs that it may also fail soon.…”