Background: The emergence and spread of antimicrobial resistance (AMR) in Neisseria gonorrhoeae, nationally and internationally, is a serious threat to the management and control of gonorrhoea. Limited and conflicting data regarding the epidemiological drivers of gonococcal AMR internationally have been published. We examined the antimicrobial susceptibility/resistance of gonococcal isolates (n = 15,803) collected across 27 European Union/European Economic Area (EU/EEA) countries in 2009–2016, in conjunction to epidemiological and clinical data of the corresponding patients, to elucidate associations between antimicrobial susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection. Methods: In total, 15,803 N. gonorrhoeae isolates from the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), 2009–2016, were examined. Associations between gonococcal susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection were investigated using univariate and multivariate logistic regression analysis. Statistical significance was determined by Pearson χ2-test or Fisher’s exact test with two-tailed p-values of < 0.05 indicating significance. Results: The overall gonococcal resistance from 2009 to 2016 was 51.7% (range during the years: 46.5–63.5%), 7.1% (4.5–13.2%), 4.3% (1.8–8.7%), and 0.2% (0.0–0.5%) to ciprofloxacin, azithromycin, cefixime, and ceftriaxone, respectively. The level of resistance combined with decreased susceptibility to ceftriaxone was 10.2% (5.7–15.5%). Resistance to cefixime and ciprofloxacin, and resistance combined with decreased susceptibility to ceftriaxone were positively associated with urogenital infections and heterosexual males, males with sexual orientation not reported and females (except for ciprofloxacin), i.e. when compared to men-who-have-sex-with-men (MSM). Azithromycin resistance was positively associated with heterosexual males, but no association was significant regarding anatomical site of infection. Conclusions: Overall, sexual orientation was the main variable associated with gonococcal AMR. Strongest positive associations were identified with heterosexual patients, particularly males, and not MSM. To provide evidence-based understanding and mitigate gonococcal AMR emergence and spread, associations between antimicrobial susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection need to be further investigated in different geographic settings. In general, these insights will support identification of groups at increased risk and targeted public health actions such as intensified screening, 3-site testing using molecular diagnostics, sexual contact tracing, and surveillance of treatment failures.
Bibliographical noteFunding Information:
We would like to thank the members of the European STI network for their active participation in Euro-GASP: Austria: Claudia Eder, Sonja Pleininger, Alexander Indra, Steliana Huhlescu; Belgium: Irith De Baetselier, Wim Vanden Berghe; Croatia: Bla?enka Hunjak, Tatjana Nemeth Bla?i?; Cyprus: Panayiota Maikanti-Charalambous, Despo Pieridou; Czech Republic: Hana Z?kouck?, Helena ?emli?kov?; Denmark: Steen Hoffmann, Lasse Jessen Schwartz; Estonia: Rita Peetso, Jevgenia Epstein, Jelena Viktorova; France: Ndeindo Ndeikoundam, Beatrice Bercot, C?cile B?b?ar, Florence Lot; Germany: Susanne Buder, Klaus Jansen; Greece: Vivi Miriagou, Georgios Rigakos, Vasilios Raftopoulos; Hungary: Eszter Balla, M?ria Dud?s; Iceland: Lena R?s ?smundsd?ttir, Gu?r?n Sigmundsd?ttir, Gu?r?n Svanborg Hauksd?ttir, Thorolfur Gudnason; Ireland: Aoife Colgan, Brendan Crowley, Sin?ad Saab; Italy: Paola Stefanelli, Anna Carannante, Patrizia Parodi; Latvia: Gatis Pakarna, Raina Nikiforova, Antra Bormane, Elina Dimina; Luxembourg: Monique Perrin, Tamir Abdelrahman, Jo?l Mossong, Jean-Claude Schmit, Friedrich M?hlschlegel; Malta: Christopher Barbara, Francesca Mifsud; the Netherlands: Alje Van Dam, Birgit Van Benthem, Maartje Visser, Ineke Linde; Norway: Hilde Kl?vstad, Dominique Caugant; Poland: Beata M?ynarczyk-Bonikowska; Portugal: Jacinta Azevedo, Maria-Jos? Borrego, Marina Lurdes Ramos Nascimento; Slovak Republic: Peter Pavlik; Slovenia: Irena Klavs, Andreja Murnik, Samo Jeverica, Sandra Kosmac, Tanja Kustec; Spain: Julio V?zquez Moreno, Asuncion Diaz, Raquel Abad; Sweden: Inga Velicko, Magnus Unemo; United Kingdom: Gwenda Hughes, Jill Shepherd, Lynsey Patterson.
© 2021, The Author(s).
Copyright 2021 Elsevier B.V., All rights reserved.
- Antimicrobial resistance
- European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)