UK health officials are reporting a confirmed multi-drug-resistant isolate of Neisseria gonorrhoeae in a heterosexual man recently. He reported one regular female partner in the UK, and a female sexual contact in south-east Asia a month prior to symptom onset.

Neisseria gonorrhoeae/CDC
Neisseria gonorrhoeae/CDC

According to testing performed by the Public Health England (PHE) Reference Laboratory, the strain was resistant to the current recommended dual first-line therapy. The isolate has a ceftriaxone MIC of 0.5 mg/L and an azithromycin MIC of >256 mg/L (high-level azithromycin resistant, HLAziR). On wider antimicrobial susceptibility testing, the strain was susceptible only to spectinomycin.

This is the first global report of HLAziR N. gonorrhoeae which is also resistant to ceftriaxone.

The patient is being treated with IV ertapenem. The ertapenem MIC was low (0.032 mg/L) suggesting that this may be an effective therapy, although there are no defined breakpoints.

Follow-up of the case and sexual contacts is ongoing. The provisional test result from the UK sexual contact was negative.