The European Centre for Disease Prevention and Control (ECDC) has recorded a worryingly dramatic surge of antimicrobial resistance (AMR) amid a substantial increase in gonorrhoea infections, including among women, according to new data released last week.
Of the 4 396 Neisseria gonorrhoeae isolates submitted by 23 European Union/European Economic Area (EU/EEA) countries to the European Gonococcal Antimicrobial Surveillance Programme in 2022, 25.6% were resistant to azithromycin, compared with 14.2% in 2021.
This is noteworthy, reports CIDRAP, because although ceftriaxone is the recommended antibiotic for treating gonorrhoea throughout Europe and elsewhere, azithromycin is often used in combination with ceftriaxone to ensure treatment success.
In addition, two isolates with resistance to ceftriaxone were detected – one each in Austria and Germany. One isolate was extensively drug-resistant and the other multidrug-resistant, with one displaying “high-level” azithromycin resistance.
ECDC officials say the detection of ceftriaxone resistance, in combination with rising azithromycin resistance, is a concerning trend.
“Although dual ceftriaxone and azithromycin resistance is exceedingly rare in the EU/EEA, the rapidly decreasing azithromycin susceptibility combined with the continued detection of occasional ceftriaxone resistance is still of concern and threatens the effectiveness of treatment and control of gonorrhoea,” the ECDC said.
Gonorrhoea cases up 48%
The data also show that resistance to ciprofloxacin, which can be an alternative treatment when isolates are shown to be susceptible, rose to 65.9% from 62.8% in 2021 and 57.7% in 2020.
Cefixime resistance remained low, at 0.3%, but ECDC officials cautioned that it needs to be monitored closely, since gonococcal strains with resistance to both ceftriaxone and cefixime are spreading internationally.
The rise in drug resistance was accompanied by a dramatic rise in gonorrhoea infections. A total of 70 881 confirmed cases were reported from 28 EU/EEA countries in 2022, a 48% increase from 2021.
Although a strong majority of gonococcal isolates were from men (80.9%), a significant increase was seen in the proportion of specimens from women – 19.1% compared with 13.9% in 2021. The proportion of samples from people under 25 rose to 28.4%, up from 23.2% in 2021.
The ECDC said that while investments in new antibiotics and alternative regimens will be necessary to stay ahead of the evolving resistance in gonorrhoea, stronger antimicrobial susceptibility surveillance and public health initiatives aimed at reducing the number of cases – including increased access to testing and early treatment – are also needed to ensure that it remains a treatable infection.
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CIDRAP article – ECDC report highlights rising drug-resistance in gonorrhoea 9Open access)
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