Australian Gonococcal Surveillance Programme Annual Report, 2021
DOI:
https://doi.org/10.33321/cdi.2022.46.52Keywords:
antimicrobial resistance, disease surveillance, gonococcal infection, Neisseria gonorrhoeaeAbstract
The Australian Gonococcal Surveillance Programme, established in 1981, has continuously monitored antimicrobial resistance in Neisseria gonorrhoeae for more than 40 years. In 2021, a total of 6,254 isolates from patients in the public and private sectors, in all jurisdictions, were tested for in vitro antimicrobial susceptibility by standardised methods.
The current treatment recommendation for gonorrhoea, for the majority of Australia, continues to be dual therapy with ceftriaxone and azithromycin. In 2021, of isolates tested, 0.9% were reported nationally with decreased susceptibility (DS) to ceftriaxone (minimum inhibitory concentration [MIC] value ≥ 0.06 mg/L). There was one isolate from non-remote Western Australia that was resistant to ceftriaxone (MIC value ≥ 0.25 mg/L).
Resistance to azithromycin (MIC value ≥ 1.0 mg/L) was reported nationally in 4.7% of N. gonorrhoeae isolates. This is increased from that reported in 2020 (3.9%) but similar to the percentage reported in 2019 (4.6%). Isolates with high-level resistance to azithromycin (MIC value ≥ 256 mg/L) are identified sporadically in Australia; none were reported in 2021.
In 2021, penicillin resistance was found in 38% of gonococcal isolates nationally, and ciprofloxacin resistance in 53%; however, there is considerable variation by jurisdiction. In some remote settings, penicillin resistance remains low; in these settings, penicillin continues to be recommended as part of an empiric therapy strategy. In 2021, in remote Northern Territory, one penicillin-resistant isolate was reported, and in remote Western Australia 2/83 of gonococcal isolates (2.4 %) were penicillin resistant. There were two ciprofloxacin-resistant isolates reported from remote Northern Territory; ciprofloxacin resistance rates remain comparatively low in remote Western Australia (3/83; 3.6 %).
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References
Lahra MM, George CR, Whiley DM. The Australian Gonococcal Surveillance Programme 1979–2017. Microbiol Aust. 2017;38(4):175–9.
Lahra MM, Martin I, Demczuk W, Jennison AV, Lee KI, Nakayama SI et al. Cooperative recognition of internationally disseminated ceftriaxone-resistant Neisseria gonorrhoeae strain. Emerg Infect Dis. 2018;24(4):735–40. doi: https://doi.org/10.3201/eid2404.171873.
Whiley DM, Jennison A, Pearson J, Lahra MM. Genetic characterisation of Neisseria gonorrhoeae resistant to both ceftriaxone and azithromycin. Lancet Infect Dis. 2018; 18(7):717–8. doi: https://doi.org/10.1016/S1473-3099(18)30340-2.
European Centre for Disease Prevention and Control (ECDC). Rapid risk assessment: extensively drug-resistant (XDR) Neisseria gonorrhoeae in the United Kingdom and Australia. [Internet.] Stockholm: ECDC; 7 May 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-extensively-drug-resistant-xdr-neisseria-gonorrhoeae-united.
Tapsall JW, Limnios EA, Murphy DM. Analysis of trends in antimicrobial resistance in Neisseria gonorrhoeae isolated in Australia, 1997–2006. J Antimicrob Chemother. 2008;61(1):150–5. doi: https://doi.org/10.1093/jac/dkm434.
Hanrahan JK, Hogan TR, Buckley C, Trembizki E, Mitchell H, Lau CL et al. Emergence and spread of ciprofloxacin-resistant Neisseria gonorrhoeae in New South Wales, Australia: lessons from history. J Antimicrob Chemother. 2019;74(8):2214–9. doi: https://doi.org/ 10.1093/jac/dkz182.
Armstrong BH, Limnios A, Lewis DA, Hogan T, Kundu R, Ray S et al. Is gentamicin a viable therapeutic option for treating resistant Neisseria gonorrhoeae in New South Wales? Commun Dis Intell (2018). 2021;45. doi: https://doi.org/10.33321/cdi.2021.45.12.
Australian Government Department of Health. National Notifiable Diseases Surveillance System: Public datasets. [Internet.] Canberra: Australian Government Department of Health; 2021. [Accessed on 14 April 2022.] Available from: https://www1.health.gov.au/internet/main/publishing.nsf/Content/ohp-pub-datasets.htm.
Kirby Institute. National update on HIV, viral hepatitis and sexually transmissible infections in Australia: 2009 –2018. Sydney: Kirby Institute, University of New South Wales; 2020. Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/National-update-on-HIV-viral-hepatitis-and-STIs-2009-2018.pdf.
Lahra MM, Enriquez R. Australian Gonococcal Surveillance Programme annual report, 2016. Commun Dis Intell (2018). 2018;42:S2209-6051(18)00013-1.
Family Planning Association. Sexually transmitted infections factsheet. [Internet.] Derby: United Kingdom Family Planning Association; 2016. Available from: https://www.fpa.org.uk/factsheets/sexually-transmitted-infections.
Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases Surveillance 2016. Atlanta: United States Department of Health and Human Services, CDC; 21 September 2017. Available from: https://www.cdc.gov/std/stats16/CDC_2016_STDS_Report-for508WebSep21_2017_1644.pdf.
ECDC. Annual epidemiological report 2016 – gonorrhoea. [Internet.] Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/documents/Gonorrhoea%20AER_0.pdf.
Government of Canada. Gonorrhea. [Internet.] Ottawa: Government of Canada; 9 August 2021. Available from: https://www.canada.ca/en/public-health/services/diseases/gonorrhea.html.
Tapsall J, World Health Organization (WHO) Anti-Infective Drug Resistance Surveillance and Containment Team. Antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2001. Available from: https://apps.who.int/iris/handle/10665/66963.
WHO. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Geneva: WHO; 2012. Available from: https://apps.who.int/iris/handle/10665/44863.
Goire N, Freeman K, Tapsall JW, Lambert SB, Nissen MD, Sloots TP et al. Enhancing gonococcal antimicrobial resistance surveillance: a real-time PCR assay for detection of penicillinase-producing Neisseria gonorrhoeae by use of noncultured clinical samples. J Clin Microbiol. 2011;49(2):513–8. doi: https://doi.org/10.1128/JCM.02024-10.
Speers DJ, Fisk RE, Goire N, Mak DB. Non-culture Neisseria gonorrhoeae molecular penicillinase production surveillance demonstrates the long-term success of empirical dual therapy and informs gonorrhoea management guidelines in a highly endemic setting. J Antimicrob Chemother. 2014;69(5):1243–7. doi: https://doi.org/10.1093/jac/dkt501.
Lahra MM, Hogan TR, Shoushtari M, Armstrong BH. Australian Gonococcal Surveillance Programme annual report, 2020. Commun Dis Intell (2018). 2021;45. doi: https://doi.org/10.33321/cdi.2021.45.24.
Tapsall JW, Australian Gonococcal Surveillance Programme. Use of a quality assurance scheme in a long-term multicentric study of antibiotic susceptibility of Neisseria gonorrhoeae. Genitourin Med. 1990;66(1):8–13. doi: https://doi.org/10.1136/sti.66.1.8.
Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Coleman K, Buchbinder SP. High interest in doxycycline for sexually transmitted infection postexposure prophylaxis in a multicity survey of men who have sex with men using a social networking application. Sex Transm Dis. 2019;46(4):e32–4. doi: https://doi.org/10.1097/OLQ.0000000000000942.
Bolan RK, Beymer MR, Weiss RE, Flynn RP, Leibowitz AA, Klausner JD. Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: a randomized, controlled pilot study. Sex Transm Dis. 2015;42(2):98–103. doi: https://doi.org/10.1097/OLQ.0000000000000216.
Chow E, Fairley C. Use of doxycycline prophylaxis against STI among gay and bisexual men taking pre-exposure prophylaxis in Melbourne. Sex Transm Infect. 2019;95(Suppl 1):A201. doi: https://doi.org/10.1136/sextrans-2019-sti.508.
Brown BL, Krysiak CR, Kamanga SG, Mapanje C, Kanyamula H, Banda B et al. Neisseria gonorrhoeae antimicrobial susceptibility in Lilongwe, Malawi, 2007. Sex Transm Dis. 2010;37(3):169–72. doi: https://doi.org/10.1097/OLQ.0b013e3181bf575c.
Ohnishi M, Golparian D, Shimuta K, Saika T, Hoshina S, Iwasaku K et al. Is Neisseria gonorrhoeae initiating a future era of untreatable gonorrhea?: detailed characterization of the first strain with high-level resistance to ceftriaxone. Antimicrob Agents Chemother. 2011;55(7):3538–45. doi: https://doi.org/10.1128/AAC.00325-11.
Cámara J, Serra J, Ayats J, Bastida T, Carnicer-Pont D, Andreu A, et al. Molecular characterization of two high-level ceftriaxone-resistant Neisseria gonorrhoeae isolates detected in Catalonia, Spain. J Antimicrob Chemother. 2012;67(8):1858–60. doi: https://doi.org/10.1093/jac/dks162.
Unemo M, Golparian D, Nicholas R, Ohnishi M, Gallay A, Sednaoui P. High-level cefixime- and ceftriaxone-resistant Neisseria gonorrhoeae in France: novel penA mosaic allele in a successful international clone causes treatment failure. Antimicrob Agents Chemother. 2012;56(3):1273–80. doi: https://doi.org/10.1128/AAC.05760-11.
Lahra MM, Ryder N, Whiley DM. A new multidrug-resistant strain of Neisseria gonorrhoeae in Australia. N Engl J Med. 2014;371(19):1850–1. doi: https://doi.org/10.1056/NEJMc1408109.
Unemo M. Current and future antimicrobial treatment of gonorrhoea – the rapidly evolving Neisseria gonorrhoeae continues to challenge. BMC Infect Dis. 2015;15:364. doi: https://doi.org/10.1186/s12879-015-1029-2.
Stevens K, Zaia A, Tawil S, Bates J, Hicks V, Whiley D et al. Neisseria gonorrhoeae isolates with high-level resistance to azithromycin in Australia. J Antimicrob Chemother. 2015;70(4):1267–8. doi: https://doi.org/10.1093/jac/dku490.
Whiley DM, Lahra MM, Unemo M. Prospects of untreatable gonorrhea and ways forward. Future Microbiol. 2015;10(3):313–6. doi: https://doi.org/10.2217/fmb.14.138.
WHO. WHO guidelines for the treatment of Neisseria gonorrhoeae. Geneva: WHO; 1 January 2016. Available from: https://www.who.int/publications/i/item/9789241549691.
Bourne C, Chen M, Lahra M, Lewis D, Marshall L, Paterson D et al. Recommendations for treatment of gonococcal infections in the era of MDR/XDR gonorrhoea (Document for sexual health and infectious diseases specialists). [Internet.] Sydney: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM); 2019. [Accessed on 8 October 2020.] Available at: https://ashm.org.au/sexual-health/cdna_xdrgonorrhoea_recommendations/.
Ross JDC, Brittain C, Cole M, Dewsnap C, Harding J, Hepburn T et al. Gentamicin compared with ceftriaxone for the treatment of gonorrhoea (G-ToG): a randomised non-inferiority trial. Lancet. 2019; 393(10190):2511–20. doi: https://doi.org/10.1016/S0140-6736(18)32817-4.
Barbee LA, Soge OO, Morgan J, Leclair A, Bass T, Werth BJ et al. Gentamicin alone is inadequate to eradicate Neisseria gonorrhoeae from the pharynx. Clin Infect Dis. 2019;71(8):1877–82. doi: https://doi.org/10.1093/cid/ciz1109.
Fifer H, Hughes G, Whiley D, Lahra MM. Lessons learnt from ceftriaxone-resistant gonorrhoea in the UK and Australia. Lancet Infect Dis. 2020;20(3):276–8. doi: https://doi.org/10.1016/S1473-3099(20)30055-4.
Traeger MW, Cornelisse VJ, Asselin J, Price B, Roth NJ, Willcox J et al. Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among Individuals at high risk of HIV infection. JAMA. 2019;321(14):1380–90. doi: https://doi.org/ 10.1001/jama.2019.2947.
Holt M, Lea T, Mao L, Kolstee J, Zablotska I, Duck T et al. Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013–17. Lancet HIV. 2018;5(8):e448–56. doi: https://doi.org/10.1016/S2352-3018(18)30072-9.
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