O19 Reversing trends in Neisseria gonorrhoeae susceptibility to ceftriaxone and cefixime in England and Wales: 2018 to 2020 results from the gonococcal resistance to antimicrobials surveillance programme (GRASP). (16th June 2022)

• Record Type: Journal Article
• Authors: Sun, Suzy; Fifer, Helen; Pitt-Kendall, Rachel; Cole, Michelle; Day, Michaela
• Is Part Of: Sexually transmitted infections. Volume 98(2022)Supplement 1
• Page Start: A10
• Page End: A10
• Publication Date: 2022-06-16
• Subjects: Sexually transmitted diseases -- Periodicals; HIV infections -- Periodicals; 616.951005
• DOI: 10.1136/sextrans-BASHH-2022.19
• Languages: English
• ISSNs: 1368-4973

Abstract

Abstract : Introduction: Ceftriaxone is the last-line option for empirical treatment of gonorrhoea. No ceftriaxone resistance (MIC >0.125 mg/L) has been identified in GRASP. However, the proportion of isolates with reduced susceptibility to ceftriaxone (MIC >0.03 mg/L) rose from 0.3% in 2013 to 7.1% in 2018. This trend reversed in the last 2 years; to 2.9% in 2019 and 1.4% in 2020. Similarly, there was a reduction in cefixime resistance (MIC >0.125 mg/L) from 2.2% in 2018 to 0.6% in 2020. We sought to characterise this further. Methods: Data from GRASP 2018 to 2020 were extracted and the prevalence of reduced susceptibility or resistance to ceftriaxone and cefixime (respectively) were compared. These were stratified by risk factors including age, sexual orientation, ethnicity, sex abroad, previous gonorrhoea infection, HIV status and site of infection. Results: The largest decreases in reduced susceptibility to ceftriaxone were observed among those aged 35-44 (7.9%, p<0.001), MSM (7.9%, p<0.001) and pharyngeal site of infection (13.3%, p<0.001). The reduction in cefixime resistance followed a different pattern for which decreases were most prominent among non-MSM groups (3.1% in heterosexual males, p=0.002; 3.3% in females, p=0.006). Discussion: These trends are encouraging and may, in part, be due to the change in treatment guidelines for gonorrhoea in 2019 in the UK, whereby dual therapy with ceftriaxone 500mg plus azithromycin was replaced with a higher dose ceftriaxone 1g monotherapy. The contrasting patterns of decline when comparing sexual orientation between the two cephalosporins requires further investigation, including whole-genome sequencing of isolates to explore changes in the gonococcal population.