Trends and Risk Factors for Antimicrobial-Resistant Neisseria gonorrhoeae , Melbourne, Australia, 2007 to 2018

Abstract

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a major public health problem. Traditionally, AMR surveillance programs for N. gonorrhoeae have focused mainly on laboratory data to describe the prevalence and trends of resistance. However, integrating individual-level risk factors (e.g., sexual orientation or international travel) with laboratory data provides important insights into factors promoting the spread of resistant N. gonorrhoeae. Here, over a 12-year period, we assessed the trends and risk factors for resistant N. gonorrhoeae in individuals attending a large publicly funded sexual health center in Melbourne, Australia. A total of 7,588 N. gonorrhoeae isolates were cultured from 5,593 individuals between 1 January 2007 and 31 December 2018. The proportion of isolates with penicillin resistance decreased from 49.5% in 2007 to 18.3% in 2018 (ptrend < 0.001) and from 63.5% in 2007 to 21.1% in 2018 for ciprofloxacin resistance (ptrend < 0.001). In contrast, the proportion of isolates displaying decreased susceptibility to ceftriaxone increased from 0.5% in 2007 to 2.9% in 2018 (ptrend < 0.001), with a significant increase in low-level azithromycin resistance, from 2.5% in 2012 to 8.2% in 2018 (ptrend < 0.001). Multivariate analysis identified risk factors for multidrug-resistant (MDR) N. gonorrhoeae, namely, female sex and country of birth, with MDR isolates more common in individuals born in northeast Asia, further highlighting the importance of this region and international travel as factors in the cross-border transmission of MDR N. gonorrhoeae. Future surveillance work should incorporate additional epidemiological and genomic data to provide a comprehensive overview of the emergence and spread of resistant N. gonorrhoeae.

Trends and differences in sexual practices and sexually transmitted infections in men who have sex with men only (MSMO) and men who have sex with men and women (MSMW): a repeated cross-sectional study in Melbourne, Australia

“… 23 Furthermore, MSMW are also less likely to ever have an HIV/STI test compared with MSMO, 23 26 27 which is consistent with an Australian qualitative study suggesting MSMW have a poor sexual health knowledge compared with MSMO. 28 Furthermore, the rise in antimicrobial resistance in STI, 29 particularly gonorrhoea, is of particular concern. Transmission of antimicrobial resistance across risk populations (eg, between MSMW and female) may have occurred.…”

Sharp increase in ciprofloxacin resistance of Neisseria gonorrhoeae in Yaounde, Cameroon: analyses of a laboratory database period 2012–2018

“…We also do not know if among the azithromycin-resistant isolates high MIC values were present, as has been described elsewhere. 24,25 Challenges were identified while examining this database and analysing the results. Over the years, different manufacturers were solicited for the provision of nitrocefin and oxidase reagents, and shortages of reagents were not infrequent.…”

“…We also do not know if among the azithromycin-resistant isolates high MIC values were present, as has been described elsewhere. 24,25…”

Seasonal variations in kissing and sexual activities among men who have sex with men in Melbourne, Australia: implications for seasonal sexually transmissible infection preventions and interventions

“…Furthermore, the rise in antimicrobial-resistant Neisseria gonorrhoeae has become an emerging public health concern globally. [17][18][19][20] Several treatment failure cases, particularly oropharyngeal gonorrhoea infections, have been reported worldwide, [21][22][23] and this is likely due to the oropharynx being considered as an important reservoir of antimicrobial-resistant gonorrhoea infection. 16,24 In this context, understanding the transmission of oropharyngeal gonorrhoea, in particular the role of kissing, is critical to its effective control.…”