P681 Importation of ciprofloxacin resistant neisseria gonorrhoeae into the UK: a public health challenge. (14th July 2019)

• Record Type: Journal Article
• Authors: Furegato, Martina; Broad, Claire; Phillips, Laura; Harrison, Mark; Pond, Marcus; Zhou, Liqing; Tan, Ngeekeong; Okala, Sandra; Fuller, Sebastian; Tariq Sadiq, S; Harding-Esch, Emma
• Is Part Of: Sexually transmitted infections. Volume 95(2019)Supplement 1
• Page Start: A298
• Page End: A298
• Publication Date: 2019-07-14
• Subjects: Neisseria gonorrhoeae -- antimicrobial resistance -- travel; Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-2019-sti.747
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Background: Current UK guidelines for managing Neisseria gonorrhoeae (NG) infection include ciprofloxacin use if antimicrobial susceptibility is indicated, but this option would be less useful if ciprofloxacin resistant NG (CpR-NG) rates increased, for example to levels reported in some parts of Asia. CpR-NG rates in the Americas are lower than in the UK. We investigated whether having recent condomless sex in "high" CpR-NG (HCpR-NG) regions (sex abroad, but not in the Americas) was associated with being infected with CpR-NG. Methods: We conducted two cross-sectional surveys of UK Sexual Health Clinics (March 2015-March 2016; May 2017-June 2018). Patients aged ≥16 years with symptoms of an STI provided samples: vulvovaginal swab (females); first void urine (men-who-have-sex-with-women (MSW) and men-who-have-sex-with-men (MSM)); pharyngeal and rectal swabs (MSM). Data were collected on travel-associated sexual behaviour, including condomless sex abroad (CSA) in the past three months with a new partner. Routine clinic NG results were obtained. Resistance-associated mutations in gyrA (fluoroquinolones) for NG were identified using Sanger sequencing. Patients reporting CSA in HCpR-NG regions were compared to no sex abroad using Pearson's chi-squared test and multivariable logistic regression models. Results: Overall, 71/1055 (6.7%) reported CSA in HCpR-NG regions. Of these, 12/71 (16.9%) compared to 85/984 (8.6%) not reporting CSA had NG (p=0.02). Among-NG positive patients, fluoroquinolone resistant mutations were found in 9/12 (75.0%) patients reporting CSA in HCpR-NG regions, compared to 35/85 (41.2%) who did not report CSA (p=0.03). After adjustment for other risk factors, the association between fluoroquinolone resistant NG and CSA in HCpR-NG regions remained significant (aOR:2.33[95%CI:1.03–5.24]). Conclusion: Having recent condomless sex with a new partner in regions of high ciprofloxacin resistance was associated with being NG-positive in the UK and having ciprofloxacin resistant NG. Importation of resistance may undermine attempts to recycle older antibiotics in the management of NG infection. Disclosure: No significant relationships.