Background: Gonorrhoea is the second most commonly diagnosed bacterial sexually transmitted infection in the United Kingdom. Effective treatment is threatened by the emergence of decreased susceptibility (DS) of Neisseria gonorrhoeae to currently prescribed cephalosporins. In 2010, ceftriaxone replaced cefixime as the recommended front-line therapy. We investigated recent patterns and risk factors associated with gonococcal DS to cephalosporins in response to this change using national surveillance data.
Methods: GRASP is a national sentinel surveillance programme that monitors antimicrobial resistance in N. gonorrhoeae in England and Wales. Between July-September, 2012, consecutive gonococcal isolates from patients diagnosed with gonorrhoea attending 25 STD clinics were submitted for antimicrobial susceptibility testing to determine the Minimum Inhibitory Concentrations (MICs). Antimicrobial results and linked patient clinical data from the national STD surveillance database (GUMCADv2) were analysed using Pearson’s chi-square test and univariate logistic regression to determine risk factors associated with isolate(s) exhibiting DS to specific antimicrobials.
Results: 1535 gonococcal isolates, representing 5.9% of all gonorrhoea diagnoses in England and Wales in 2012 were included. There was a significant decline (p<0.001) in the proportion of isolates exhibiting DS to cefixime (MIC≥0.125mg/L) from 10.8% in 2011 to 5.6% in 2012. This second year of decline followed a rise from 1.5% to 17.1% between 2007 and 2010. The risk of infection with an isolate exhibiting DS to cefixime (MIC≥0.125mg/L) increased with patients’ age (p=0.004), being male or reporting sexual contact outside the UK (p<0.0001). Three isolates (0.2%) infecting men who have sex with men exhibited DS to ceftriaxone (MIC≥0.125mg/L) and an increasing drift in ceftriaxone MICs was clearly evident in this group.
Conclusions: There may have been a reduction in DS in cefixime in response to changes in UK treatment guidelines in 2010; however, identification of increasing MICs to ceftriaxone needs continuous monitoring for early detection of treatment failures.