One year of Neisseria gonorrhoeae isolates in Sweden: the prevalence study of antibiotic susceptibility shows relation to the geographic area of exposure

Abstract

The aim of this study was to compare epidemiological data with antibiotic susceptibility patterns, so as to characterize the risk of infection with a highly resistant Neisseria gonorrhoeae strain. N. gonorrhoeae strains isolated in Sweden from February 1998 through January 1999 were tested for antibiotic susceptibility. Epidemiological data were received from each clinician reporting a case of gonorrhoea and these data were linked to the N. gonorrhoeae strains. A total of 348 N. gonorrhoeae isolates, representing 89% of all Swedish cases diagnosed during the 12-month period, were tested for antibiotic susceptibility. Of all isolates, 24% were beta-lactamase-producing, and 18% had decreased susceptibility to ciprofloxacin (MIC>0.064 mg/l). All isolates were fully susceptible to ceftriaxone and spectinomycin. More than 99% of the isolates were fully susceptible to azithromycin. The antibiotic susceptibility varied with the places where patients were exposed to infection. When exposed in Asia, 63% of the isolates showed reduced susceptibility to ciprofloxacin, compared with 0-8.5% of the isolates from patients exposed in other places (RR=8.5, P<0.001). Ciprofloxacin cannot be recommended as the first choice of treatment if the place of exposure was in Asia.

Molecular characterization of Neisseria gonorrhoeae identifies transmission and resistance of one ciprofloxacin‐resistant strain

“…Neisseria gonorrhoeae. Nowadays, a high level of decreased susceptibility or resistance to most traditional antibiotics used for treatment of gonorrhoea has been identified in most countries [2][3][4][5]). In addition, the characteristics of circulating N. gonorrhoeae strains fluctuate over time and a highly discriminative and objective characterization, i.e.…”

“…Since 1997 the incidence of gonorrhoea in Sweden has increased almost annually (Gonorrhoea/ year and month statistics per county http://gis.smittskyddsinstitutet.se/mapapp/build/intro_eng.html (3,8)). According to previous studies (8,10,12), the transmission of single strains in Swedish society may result in large domestic core groups of gonorrhoea cases and it is possible to identify these strains with a precise genetic characterization of the bacterial isolates.…”

“…This genetic typing may identify the transmission of more virulent and/or antibiotic-resistant strains, information that is important for the development of improved control measures. Conventional phenotypic characterization of N. gonorrhoeae strains has several limitations (6-10) and many genetic methods have been developed to overcome these shortcomings (11).Since 1997 the incidence of gonorrhoea in Sweden has increased almost annually (Gonorrhoea/ year and month statistics per county http://gis.smittskyddsinstitutet.se/mapapp/build/intro_eng.html (3,8)). According to previous studies (8,10,12), the transmission of single strains in Swedish society may result in large domestic core groups of gonorrhoea cases and it is possible to identify these strains with a precise genetic characterization of the bacterial isolates.…”

“…(SWEDRES 2004 http://www.strama.se (2)(3)(4)(5)). In addition, the characteristics of circulating N. gonorrhoeae strains fluctuate over time and a highly discriminative and objective characterization, i.e.…”

Molecular Epidemiology of Neisseria gonorrhoeae : Sequence Analysis of the porB Gene Confirms Presence of Two Circulating Strains

“…In a 1-year prevalence study conducted during this increase, clinical and epidemiological data were prospectively obtained for all cases of gonorrhea reported in Sweden and the N. gonorrhoeae isolates were phenotypically characterized (1,2). Two core groups with domestic cases were identified: homosexual men in whom N. gonorrhoeae serovar IB-2 was the most prevalent serological variant and young heterosexuals of both sexes in whom serovar IB-3 was the most prevalent serological variant (1).…”