The effectiveness of first-line treatment for gonorrhoea continues to be threatened by the development of antimicrobial resistance, according to the latest Public Health England (PHE) data.
Between 2017 and 2018, there was a reduction in susceptibility to the current first-line therapy, ceftriaxone: The percentage of isolates with minimum inhibitory concentration (MICs) ≥0.03 mg/L rose from 16.6% in 2017 to 24.6% in 2018.
Neisseria gonorrhoeae isolates from men who have sex with men were less susceptible to ceftriaxone, cefixime, and azithromicin than those from women and heterosexual men, said PHE.
In 2018, three cases of extensively drug-resistant N.gonorrhoeae were identified in UK residents, all with epidemiological links to sexual networks in Southeast Asia or Spain, PHE notes.
Gonococcal isolates collected through PHE’s Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) sentinel surveillance system between 2017 and 2018 showed:
· A n increase in resistance to azithromycin from 9.3% to 9.7%.
· An increase in resistance to ciprofloxacin from 36.4% to 39.8%.
· An increase in resistance to cefixime from 1.7% to 2.1%.
· An increase in resistance to penicillin from 10.8% to 12.4%.
· An increase in resistance to tetracycline from 48.5% to 52.8%.
All primary diagnostic laboratories should test gonococcal isolates for susceptibility to ceftriaxone and azithromycin, and refer suspected ceftriaxone-resistant and/or high-level azithromycin-resistant (MIC ≥256 mg/L) isolates to PHE’s national reference laboratory for confirmation and follow-up.
Practitioners should ensure that all patients with gonorrhoea are treated and managed according to national guidelines, and should be alert to changes to the antimicrobials recommended for first-line use, PHE said.
The new treatment guidelines for gonorrhoea, published in January 2019, recommend 1 g ceftriaxone IM monotherapy, replacing dual therapy of ceftriaxone (500 mg IM) in combination with azithromycin (1 g oral) as first-line therapy.
UK gonorrhoea diagnoses rose by 80% between 2013 and 2018 (31,201 to 56,259).