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Dutch researchers report reduced susceptibility to last effective cure for gonorrhea
An analysis of gonorrhea isolates collected over a nearly 4-year period at a sexually transmitted infection clinic in the Netherlands showed declining susceptibility to the last effective cure for gonorrhea, researchers said.
“These results confirm the reported decrease in azithromycin and ceftriaxone susceptibility in Europe,” they wrote in Eurosurveillance.
Gonorrhea, which can cause serious health problems if left untreated, has developed resistance to almost every class of antibiotics used to treat it. Increased susceptibility or resistance to standard treatment has been seen all over the world, including in the United States, where Hawaii reported the first gonorrhea cluster in the country to show both decreased susceptibility to ceftriaxone and very high resistance to azithromycin.
That news came amid a rise in STDs across the country, with the CDC announcing in October that more cases of chlamydia, gonorrhea and syphilis were reported in 2015 than any other year on record.
The Dutch researchers analyzed all consultations with a positive Neisseria gonorrhoeae culture at an STI outpatient clinic in Amsterdam from January 2012 through September 2015. Among 3,151 isolates, no resistance to ceftriaxone was seen, but around 1.2% showed resistance to azithromycin.
Decreased susceptibility was seen for both drugs. The proportion of isolates with intermediate minimum inhibitory concentration levels for azithromycin climbed from 3.7% in 2012 to 15.6% in 2014 before falling to 8.6% in the first 9 months of 2015. Likewise, the percentage of isolates showing a decreased susceptibility to ceftriaxone rose from 3.6% in 2012 to 11.8% in 2014 before falling to 8.4% in the last 9 months of the study.
“Future surveillance will demonstrate if these small decreases in reduced susceptibility continue, and if so may provide reasons for this,” the researchers wrote. “Like we published previously in 2009, decreased susceptibility or resistance to more than one drug remains common. Among isolates with decreased susceptibility to azithromycin or ceftriaxone, 35.1% and 95.7% respectively were also resistant to ciprofloxacin.”
Decreased susceptibility to azithromycin for men who have sex with men was associated with a diagnosis in 2014, two infected sites and HIV status, according to the researchers. For heterosexuals, it was associated with having 10 or more sexual partners in the previous 6 months. Decreased susceptibility to ceftriaxone in MSM was associated with diagnosis in 2014 and pharyngeal infections. For heterosexuals, it was associated with being diagnosed in 2014 or 2015, being female, and having 10 or more sex partners.
“Strains with decreased susceptibility, for either azithromycin or ceftriaxone, were significantly more often isolated from MSM compared with heterosexuals,” the researchers wrote. “This suggests that sexual orientation (or risk behavior) is associated with decreased susceptibility to both azithromycin and ceftriaxone.
“However, because of correlation with other variables, we had to stratify for sexual orientation, and could not correct this possible association for confounders. Among MSM we noted a significant association between more recent year of infection (more recent than 2012) and decreased susceptibility to both azithromycin and ceftriaxone.” – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.