European health officials are reporting an slight increase in antibiotic resistance in gonorrhea in 2013, according to a newly published report Thursday. Gonorrhea is one of the most common sexually transmitted infections on the continent.
The surveillance is critical for detecting emerging and increasing antimicrobial resistance and making quality-assured data available to inform treatment guidelines.
According to the report’s summary, during 2013, the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) followed the biannual decentralized and centralized testing model used in previous years, requesting participating laboratories to collect gonococcal isolates during two periods (April/May and October/November). For centralized testing, susceptibility testing was performed on all isolates centrally by Etest or agar dilution for the following antimicrobials: cefixime, ceftriaxone, ciprofloxacin, azithromycin, spectinomycin and gentamicin. Testing was decentralised to participating laboratories if they fulfilled set criteria.
In 2013, 21 EU/EEA Member States participated in Euro-GASP, 13 via decentralized testing. A total of 1,994 isolates were collected and tested. The majority of gonococci (85%) were collected from male patient samples. The age of the patients ranged from less than one year to 85 years, with a median of 29 years. Overall, 28% of patients were under 25 years. Males were significantly older than women. The site of specimen was mainly genital (79%), followed by rectal (13%) and pharyngeal (6%).
Among cases with information on previous diagnosis of gonorrhea, 18% had previously been diagnosed with the disease. Twenty-two per cent of the patients were concurrently diagnosed with chlamydia infection. Among cases with known sexual preference, 58% stated that they were heterosexual and 42% were men who have sex with men (MSM). Eighteen per cent of all cases were
HIV-positive and 90% of those were MSM.
In 2013, a slightly higher proportion of tested isolates showed cefixime resistance: 4.7%, compared with 3.9% in 2012. Isolates with this phenotype were detected in 13 countries, one less than in 2012. In 2013, patients who acquired a strain displaying cefixime resistance were more likely to be females or heterosexual males. Seven isolates were detected with ceftriaxone resistance (minimum inhibitory concentration (MIC)>0.125 mg/L), compared to three in 2012. Rates of ciprofloxacin resistance are very high and have been increasing since 2011 (48.7% in 2011, 50.1% in 2012, 52.9% in 2013) and the level of azithromycin resistance slightly increased (4.5% in 2012, 5.4% in 2013). One isolate displayed high-level resistance to azithromycin (MIC≥256 mg/L). The MIC distribution of gentamicin continues to offer hope that gentamicin could be considered for therapy in the future.
Twenty-one countries participated in the gonococcal antimicrobial resistance external quality assessment (EQA) scheme. The EQA has continued to show high comparability between participants, which in turn raises confidence in the quality and comparability of the gonococcal antimicrobial susceptibility testing in Euro-GASP, particularly for decentralized testing.
The increasing cefixime and ceftriaxone resistance in Europe is of concern and highlights the importance of implementing the European response plan to control the threat of multidrug-resistant N. gonorrhoeae in Europe. In addition, novel antimicrobials and/or new dual antimicrobial therapy regimens are essential to ensuring that gonorrhea remains a treatable infection.
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